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General NPI Number Information
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NPI Number | 1548825623
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Entity Type | Organization
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Legal Business Name | THERAPRO WELLNESS PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 05/04/2019
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 8931 161ST ST
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City | JAMAICA
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State | NY
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Zip | 11432-6140
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Country | US
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Telephone | 646-431-3097
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Fax |
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Provider Business Mailing Address
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Address Line | 9245 53RD AVE
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City | ELMHURST
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State | NY
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Zip | 11373-4624
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Country | US
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Telephone | 646-431-3097
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Fax |
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | ROLAND PAQUEO
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Credential | DPT
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Telephone | 646-431-3097
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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 |
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License Number State |
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