Healthcare Provider Details

I. General information

NPI: 1649961772
Provider Name (Legal Business Name): CARP PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 LAKE AVE
STATEN ISLAND NY
10303-2640
US

IV. Provider business mailing address

8402 143RD ST APT 302
JAMAICA NY
11435-2657
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-8813
  • Fax:
Mailing address:
  • Phone: 646-704-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLENE ARK REYES PIAD
Title or Position: PRESIDENT
Credential: DPT
Phone: 718-442-8813