Healthcare Provider Details

I. General information

NPI: 1801076245
Provider Name (Legal Business Name): THERA AIR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RIVERSIDE DR
PINE BUSH NY
12566-5734
US

IV. Provider business mailing address

PO BOX 963
PINE BUSH NY
12566-0963
US

V. Phone/Fax

Practice location:
  • Phone: 845-551-1801
  • Fax:
Mailing address:
  • Phone: 845-551-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JOHN E KIDD
Title or Position: CEO
Credential:
Phone: 845-551-1801