=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760813257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED PHYSICAL THERAPY OF ROCKLAND, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2013
-----------------------------------------------------
Last Update Date | 12/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 COLLEGE AVE
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-3093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-627-8220
-----------------------------------------------------
Fax | 845-215-9360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 COLLEGE AVE
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-3093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-627-8220
-----------------------------------------------------
Fax | 845-215-9360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | GAIL BOCK-FRANKEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-627-8220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 004387-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------