=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144689696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE-CARE PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2016
-----------------------------------------------------
Last Update Date | 03/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 B DUNWOOD RD
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-883-0789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 B DUNWOOD RD
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MRS. ZULMARY ANDINO
-----------------------------------------------------
Credential | PT,DPT
-----------------------------------------------------
Telephone | 516-883-0789
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 029951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------