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General NPI Number Information
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NPI Number | 1558941328
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Entity Type | Organization
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Legal Business Name | BODY HACK HIGH PERFORMANCE PT PLLC
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 1042 JACKSON AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-5819
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Country | US
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Telephone | 718-433-9909
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Fax | 718-433-9676
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Provider Business Mailing Address
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Address Line | 9972 66TH RD APT 1T
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City | REGO PARK
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State | NY
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Zip | 11374-4440
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Country | US
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Telephone | 917-733-3795
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. CARLOS HUMBERTO ZORRILLA
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Credential | PT
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Telephone | 646-238-3090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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