Healthcare Provider Details

I. General information

NPI: 1952767444
Provider Name (Legal Business Name): JC STEPPING STONE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16316 84TH ST
HOWARD BEACH NY
11414-3319
US

IV. Provider business mailing address

16316 84TH ST
HOWARD BEACH NY
11414-3319
US

V. Phone/Fax

Practice location:
  • Phone: 718-541-3575
  • Fax:
Mailing address:
  • Phone: 718-541-3575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number035669
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JUSTINE CLIFFORD
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 718-541-3575