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General NPI Number Information
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NPI Number | 1053199554
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Entity Type | Individual
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Provider Name | MORRIS SAMUEL RIBAS MONTILLA PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 295 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10017-6434
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Country | US
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Telephone | 121-268-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 27 GERANIUM AVE
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City | FLORAL PARK
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State | NY
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Zip | 11001-3012
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Country | US
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Telephone | 707-716-7118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 045308
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License Number State | NY
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