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General NPI Number Information
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NPI Number | 1023546207
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Entity Type | Organization
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Legal Business Name | GROWING UP PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 38 CAPRICORN LN
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City | MONSEY
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State | NY
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Zip | 10952-5112
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Country | US
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Telephone | 917-582-4396
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Fax | 845-694-8903
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Provider Business Mailing Address
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Address Line | 38 CAPRICORN LN
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City | MONSEY
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State | NY
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Zip | 10952-5112
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Country | US
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Telephone | 917-582-4396
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Fax | 845-694-8903
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MELINDA ANNE DE LEON
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Credential | PT, DPT
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Telephone | 917-582-4396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 023141
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 023141
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License Number State | NY
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