=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780520213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLAZE PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2026
-----------------------------------------------------
Last Update Date | 04/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 W ROUTE 59
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-826-5930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 467 PHILLIPS HILL RD
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-826-5930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SINJU THOMAS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 845-826-5930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------