Healthcare Provider Details

I. General information

NPI: 1134944523
Provider Name (Legal Business Name): MSA EMPIRE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADWAY RM 900
NEW YORK NY
10038-4348
US

IV. Provider business mailing address

150 BROADWAY RM 900
NEW YORK NY
10038-4348
US

V. Phone/Fax

Practice location:
  • Phone: 909-462-2879
  • Fax:
Mailing address:
  • Phone: 909-462-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALISA MEGHANI SOOD
Title or Position: AUTHORIZED OFFICIAL
Credential: DPT
Phone: 909-462-2879