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General NPI Number Information
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NPI Number | 1134477979
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Entity Type | Organization
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Legal Business Name | CIP PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 129-10 23RD AVE SUITE B
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City | COLLEGE POINT
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State | NY
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Zip | 11356
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Country | US
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Telephone | 718-835-4199
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 293
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City | EAST NORWICH
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State | NY
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Zip | 11732-0293
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Country | US
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Telephone | 917-797-8345
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CYNTHIA I PEREZ
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Credential | P.T.
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Telephone | 917-797-8345
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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 | 025072
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License Number State | NY
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