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General NPI Number Information
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NPI Number | 1659752558
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Entity Type | Organization
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Legal Business Name | COMPLETE SPINAL PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 2510 WESTCHESTER AVE STE 104
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City | BRONX
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State | NY
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Zip | 10461-3585
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Country | US
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Telephone | 718-892-2022
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 WESTCHESTER AVE STE 104
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City | BRONX
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State | NY
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Zip | 10461-3585
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Country | US
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Telephone | 718-892-2022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL SCOTT MINICK
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Credential | D.C.
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Telephone | 718-892-2022
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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 | 37149
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License Number State | NY
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