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General NPI Number Information
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NPI Number | 1740685817
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Entity Type | Organization
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Legal Business Name | BIG LEAP PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 3211 55TH ST APT. 1
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City | WOODSIDE
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State | NY
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Zip | 11377-1910
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Country | US
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Telephone | 646-500-0607
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Fax |
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Provider Business Mailing Address
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Address Line | 3211 55TH ST APT. 1
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City | WOODSIDE
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State | NY
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Zip | 11377-1910
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Country | US
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Telephone | 646-500-0607
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | ANA RHEEDA DEL MUNDO AGUILAR
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Credential | PT, DPT
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Telephone | 646-500-0607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 030854
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License Number State | NY
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