=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275166043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABILITY PHYSICAL REHAB SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2020
-----------------------------------------------------
Last Update Date | 02/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11605 JAMAICA AVE
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11418-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-859-8412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12326 95TH AVE
-----------------------------------------------------
City | SOUTH RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11419-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIA COMENDO SARMIENTO-YABUT
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 917-859-8412
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------