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General NPI Number Information
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NPI Number | 1093082604
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Entity Type | Organization
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Legal Business Name | FORWARD PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 1716 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11230
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Country | US
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Telephone | 718-336-4900
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Fax | 718-336-4990
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Provider Business Mailing Address
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Address Line | 1565 E 36TH ST
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City | BROOKLYN
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State | NY
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Zip | 11234-3415
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Country | US
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Telephone | 917-658-7726
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Fax | 718-682-0707
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Authorized Official
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Title or Position | OWNER
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Name | DAVID JAY ETTINGER
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Credential | PT
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Telephone | 718-336-4900
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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 | 029579
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License Number State | NY
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