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General NPI Number Information
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NPI Number | 1447790845
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Entity Type | Organization
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Legal Business Name | ROCKAWAY BEACH PHYSICAL THERAPY OF NY PLLC
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Dates
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Enumeration Date | 03/03/2017
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 11915 ROCKAWAY BEACH BLVD
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1970
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Country | US
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Telephone | 718-634-3211
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Fax | 718-634-0926
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Provider Business Mailing Address
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Address Line | 11915 ROCKAWAY BEACH BLVD
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1970
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Country | US
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Telephone | 718-634-3211
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Fax | 718-634-0926
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Authorized Official
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Title or Position | OWNER PT
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Name | MRS. KATELYN MARIE CUSMIANI
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Credential | DPT
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Telephone | 718-634-3211
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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 | 034259
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License Number State | NY
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