Healthcare Provider Details

I. General information

NPI: 1568050821
Provider Name (Legal Business Name): BULLSEYE PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 229TH ST
QUEENS VILLAGE NY
11427-2154
US

IV. Provider business mailing address

8202 229TH ST
QUEENS VILLAGE NY
11427-2154
US

V. Phone/Fax

Practice location:
  • Phone: 154-052-2249
  • Fax:
Mailing address:
  • Phone: 540-522-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FERDINIA ROSOS
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 540-522-2493