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General NPI Number Information
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NPI Number | 1649280199
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Entity Type | Organization
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Legal Business Name | BROADWAY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 289 BROADWAY
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2004
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Country | US
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Telephone | 718-448-4500
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Fax | 718-448-4506
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Provider Business Mailing Address
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Address Line | 289 BROADWAY
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2004
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Country | US
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Telephone | 718-448-4500
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Fax | 718-448-4506
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Authorized Official
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Title or Position | OWNER
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Name | THOBILE PRUDENCE SIBANDA
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Credential | PHYSICAL THERAPIST
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Telephone | 718-448-4500
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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 | 016088
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License Number State | NY
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