=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316822984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 61 BROADWAY PHYSICAL THERAPY AND REHAB PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2025
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138 5TH AVE FL 2
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-4367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-810-9347
-----------------------------------------------------
Fax | 347-438-3362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 138 5TH AVE FL 2
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-4367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-810-9347
-----------------------------------------------------
Fax | 347-438-3362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | RICHARD MARK SARMIENTO
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 917-302-8286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------