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General NPI Number Information
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NPI Number | 1053811000
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Entity Type | Organization
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Legal Business Name | TIMELESS PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 81 ELIZABETH ST STE 303
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City | NEW YORK
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State | NY
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Zip | 10013-4729
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Country | US
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Telephone | 212-219-8987
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Fax | 212-219-8982
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Provider Business Mailing Address
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Address Line | 1 FORDHAM HILL OVAL APT 3D
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City | BRONX
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State | NY
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Zip | 10468-8004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. MITZY BALDOVINO
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Credential | DPT
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Telephone | 213-880-3157
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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 | 030954
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License Number State | NY
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