Healthcare Provider Details

I. General information

NPI: 1376523001
Provider Name (Legal Business Name): PHYSIOTHERAPY REHABILITATION ORGANIZATION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEXINGTON AVE STELL3
NEW YORK NY
10010-2935
US

IV. Provider business mailing address

50 LEXINGTON AVE STE LL3
NEW YORK NY
10010-2935
US

V. Phone/Fax

Practice location:
  • Phone: 212-213-8866
  • Fax: 212-213-8868
Mailing address:
  • Phone: 212-213-8866
  • Fax: 212-213-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number005525-1
License Number StateNY

VIII. Authorized Official

Name: EBONY HARRIS
Title or Position: MANAGER
Credential:
Phone: 212-213-8866