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General NPI Number Information
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NPI Number | 1649629585
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Entity Type | Organization
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Legal Business Name | MARYCARE PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 6527 ROOSEVELT AVE # 2B
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City | WOODSIDE
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State | NY
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Zip | 11377-2927
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Country | US
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Telephone | 718-255-6887
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Fax |
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Provider Business Mailing Address
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Address Line | 4312 JUDGE ST APT 1F
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City | ELMHURST
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State | NY
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Zip | 11373-3476
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Country | US
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Telephone | 347-681-5812
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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 | MARY JANE VILCHEZ
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Credential | DPT
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Telephone | 929-478-0660
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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 | 030162
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License Number State | NY
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