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General NPI Number Information
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NPI Number | 1750192431
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Entity Type | Individual
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Provider Name | ETHAN HEALY PT
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Gender | Male
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 780 8TH AVE STE 300
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City | NEW YORK
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State | NY
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Zip | 10036-7000
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Country | US
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Telephone | 212-245-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 258 DEKALB AVE APT 2
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City | BROOKLYN
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State | NY
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Zip | 11205-3665
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Country | US
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Telephone | 901-692-4609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 053174-01
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License Number State | NY
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