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General NPI Number Information
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NPI Number | 1295145415
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 2465 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10025-7486
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Country | US
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Telephone | 212-877-2525
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Fax | 212-877-5767
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Provider Business Mailing Address
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Address Line | 576 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-5002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OF ADMINISTRATIVE OPERATIONS
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Name | LETICIA PABELLON
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Credential |
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Telephone | 516-321-2447
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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 | NY
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