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General NPI Number Information
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NPI Number | 1235643776
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Entity Type | Organization
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Legal Business Name | REFORM PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 650 BROADWAY FL 3
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City | NEW YORK
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State | NY
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Zip | 10012-2315
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Country | US
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Telephone | 212-739-9237
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2123
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City | GREENPORT
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State | NY
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Zip | 11944-0975
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Country | US
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Telephone | 212-739-9237
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. ABIGAIL BALES
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Credential | PT, DPT, CSCS
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Telephone | 212-739-9237
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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 |
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License Number State |
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