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General NPI Number Information
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NPI Number | 1548629736
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Entity Type | Organization
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Legal Business Name | PHYSIODYNAMICS LLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 14431 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11435-3623
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Country | US
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Telephone | 718-206-9839
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Fax | 718-206-2149
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Provider Business Mailing Address
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Address Line | 14431 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11435-3623
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Country | US
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Telephone | 718-206-9839
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Fax | 718-206-2149
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | DR. CARLOS M NEGRON
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Credential | DPT
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Telephone | 718-206-9839
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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 | 010400-1
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License Number State | NY
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