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General NPI Number Information
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NPI Number | 1710799937
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Entity Type | Organization
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Legal Business Name | PHOENIX MASSAGE THERAPY & PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 735 ANDERSON HILL RD
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City | PURCHASE
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State | NY
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Zip | 10577-1402
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Country | US
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Telephone | 914-806-4709
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Fax |
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Provider Business Mailing Address
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Address Line | 4 ROSEWOOD LN
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City | WINGDALE
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State | NY
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Zip | 12594-1355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE LOPEZ
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Credential |
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Telephone | 914-806-4709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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