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General NPI Number Information
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NPI Number | 1437399532
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Entity Type | Organization
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Legal Business Name | PRO CARE PHYSICAL THERAPY GROUP PC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 4111 30TH AVE STE C
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City | ASTORIA
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State | NY
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Zip | 11103-2913
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Country | US
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Telephone | 718-274-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 30TH AVE STE C
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City | ASTORIA
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State | NY
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Zip | 11103-2913
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Country | US
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Telephone | 718-274-4400
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MAURICIO MARK CLEMENTE ZAMORA
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Credential | RPT
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Telephone | 917-774-1436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 025676
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License Number State | NY
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