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General NPI Number Information
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NPI Number | 1508844036
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Entity Type | Organization
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Legal Business Name | FRESH POND PHYSICAL THERAPY, P.C
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 6805 FRESH POND RD
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5200
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Country | US
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Telephone | 718-456-2545
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Fax | 718-559-6784
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Provider Business Mailing Address
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Address Line | 68-05 FRESH POND ROAD
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City | RIDGEWOOD
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State | NY
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Zip | 11385
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Country | US
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Telephone | 718-456-2545
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Fax | 718-559-6784
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Authorized Official
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Title or Position | BILLING & COLLECTION DEPT. HEAD
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Name | JENNY TAN
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Credential |
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Telephone | 718-456-2543
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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 | 015401
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2251H1300X
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Taxonomy Name | Human Factors Physical Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 015401
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License Number State | NY
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