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General NPI Number Information
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NPI Number | 1003119678
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Entity Type | Organization
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Legal Business Name | ST KYROLLOS PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 37 PEARSON ST
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4789
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Country | US
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Telephone | 917-442-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 37 PEARSON ST
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4789
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Country | US
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Telephone | 917-442-3010
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHEL DIMIAN
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Credential | BACHELOR
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Telephone | 917-442-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 026176
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License Number State | NY
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