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General NPI Number Information
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NPI Number | 1750471124
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Entity Type | Organization
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Legal Business Name | THERA DYNAMIC PHYSICAL THERAPY P.C
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 7922 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-1801
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Country | US
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Telephone | 347-494-5684
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Fax | 347-494-5641
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Provider Business Mailing Address
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Address Line | 5043 213TH ST
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City | BAYSIDE HILLS
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State | NY
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Zip | 11364-1221
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Country | US
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Telephone | 917-783-8616
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Fax | 347-732-9011
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEE-ZEL MAY CARINGAL ANDRES
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Credential | PT
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Telephone | 347-494-5684
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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 | 025591-0
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License Number State | NY
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