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General NPI Number Information
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NPI Number | 1538573126
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Entity Type | Organization
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Legal Business Name | VALLEY STREAM PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 123 HOME ST
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City | VALLEY STREAM
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State | NY
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Zip | 11580-2705
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Country | US
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Telephone | 516-343-0867
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Fax | 888-390-5143
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Provider Business Mailing Address
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Address Line | 123 HOME ST
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City | VALLEY STREAM
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State | NY
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Zip | 11580-2705
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Country | US
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Telephone | 516-343-0867
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. GLENDA CASTANEDA
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Credential | PT, DPT
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Telephone | 516-343-0867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 017219-1
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License Number State | NY
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