Healthcare Provider Details

I. General information

NPI: 1497516363
Provider Name (Legal Business Name): ENCORE PHYSICAL THERAPY AND CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADWAY STE 712
NEW YORK NY
10038-4381
US

IV. Provider business mailing address

1410 BROADWAY RM 606
NEW YORK NY
10018-5020
US

V. Phone/Fax

Practice location:
  • Phone: 347-725-2755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAYE TAYLOR
Title or Position: MANAGER
Credential:
Phone: 212-354-2225