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General NPI Number Information
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NPI Number | 1346859493
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Entity Type | Organization
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Legal Business Name | INSPIRE PHYSICAL THERAPY WELLNESS PLLC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 9112 175TH ST APT 2B
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City | JAMAICA
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State | NY
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Zip | 11432-5571
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Country | US
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Telephone | 347-251-0690
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Fax |
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Provider Business Mailing Address
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Address Line | 1397 E SALLY CT
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City | EAST MEADOW
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State | NY
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Zip | 11554-4520
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Country | US
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Telephone | 347-251-0690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESSLEY CHACKO
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Credential |
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Telephone | 347-251-0690
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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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