=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790241644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYMBIO PHYSIOTHERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2019
-----------------------------------------------------
Last Update Date | 02/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 W 29TH ST RM 901
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-5757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-338-6268
-----------------------------------------------------
Fax | 347-694-4969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 W 29TH ST RM 901
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-5757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-338-6268
-----------------------------------------------------
Fax | 347-694-4969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | WELLNESS DIRECTOR
-----------------------------------------------------
Name | MARIA MARQUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-338-6268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------