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General NPI Number Information
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NPI Number | 1801171822
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Entity Type | Organization
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Legal Business Name | LADYBIRD CLINICAL REHAB PT PC
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 3167 E TREMONT AVE # B
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City | BRONX
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State | NY
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Zip | 10461-5718
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Country | US
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Telephone | 347-810-9742
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Fax | 347-810-9743
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Provider Business Mailing Address
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Address Line | 14 PARK AVE
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City | NEW CITY
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State | NY
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Zip | 10956-1108
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Country | US
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Telephone | 845-354-2380
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Fax | 845-354-2380
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Authorized Official
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Title or Position | PRESIDENT
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Name | LADYBIRD MANANGAN REYES
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Credential | B.S.P.T.
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Telephone | 347-810-9742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 017803
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License Number State | NY
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