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General NPI Number Information
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NPI Number | 1467104588
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Entity Type | Organization
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Legal Business Name | POLARIS PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 6529 GRAND AVE
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City | MASPETH
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State | NY
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Zip | 11378-2422
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Country | US
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Telephone | 718-715-4871
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Fax | 347-503-4090
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Provider Business Mailing Address
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Address Line | 6529 GRAND AVE
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City | MASPETH
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State | NY
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Zip | 11378-2422
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Country | US
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Telephone | 718-715-4871
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Fax | 347-503-4090
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Authorized Official
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Title or Position | CHIEF OF OPERATIONS
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Name | LYMARIS ENRIQUEZ
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Credential |
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Telephone | 718-715-4871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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