Healthcare Provider Details

I. General information

NPI: 1124025788
Provider Name (Legal Business Name): RYE PHYSICAL THERAPY & REHABILITATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 THEODORE FREMD AVE SUITE 104
RYE NY
10580-1410
US

IV. Provider business mailing address

411 THEODORE FREMD AVE SUITE 104
RYE NY
10580-1410
US

V. Phone/Fax

Practice location:
  • Phone: 914-921-6061
  • Fax: 914-921-6075
Mailing address:
  • Phone: 914-921-6061
  • Fax: 914-921-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012761
License Number StateNY

VIII. Authorized Official

Name: MATTHEW HYLAND
Title or Position: PRESIDENT
Credential: P.T.
Phone: 914-921-6061