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General NPI Number Information
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NPI Number | 1306979075
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Entity Type | Organization
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Legal Business Name | CORE PHYSICAL THERAPY & SPORT REHABILITATION PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 259 JEFFERSON BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3001
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Country | US
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Telephone | 718-356-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 259 JEFFERSON BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3001
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Country | US
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Telephone | 718-356-2919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK ANTHONY PACCHIANO
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Credential | PT/DPT
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Telephone | 719-356-2919
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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 | 021520-1
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License Number State | NY
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