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General NPI Number Information
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NPI Number | 1750911632
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Entity Type | Organization
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Legal Business Name | REPAIR PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 204 EAST 25TH STREET SUITE 1
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City | NEW YORK
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State | NY
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Zip | 10010
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Country | US
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Telephone | 347-248-6138
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Fax |
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Provider Business Mailing Address
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Address Line | 5113 61ST ST
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City | WOODSIDE
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State | NY
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Zip | 11377-5831
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Country | US
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Telephone | 347-248-6138
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Fax | 212-877-5504
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Authorized Official
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Title or Position | PRESIDENT/ PHYSICAL THERAPIST
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Name | ERIC CHAN
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Credential | DPT
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Telephone | 347-248-6138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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