Healthcare Provider Details

I. General information

NPI: 1457697427
Provider Name (Legal Business Name): REBECCA MARIE RIZACOS PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MARIE PESS PT, DPT

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 AMSTERDAM AVENUE 3RD FLOOR
NEW YORK NY
10023
US

IV. Provider business mailing address

180 AMSTERDAM AVENUE 3RD FLOOR
NEW YORK NY
10023
US

V. Phone/Fax

Practice location:
  • Phone: 646-795-3850
  • Fax:
Mailing address:
  • Phone: 646-795-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01769500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: