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General NPI Number Information
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NPI Number | 1831868256
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Entity Type | Organization
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Legal Business Name | REACTIVE PHYSICAL THERAPY & REHAB PC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 7053 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1712
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Country | US
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Telephone | 646-431-3097
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Fax | 718-770-7681
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Provider Business Mailing Address
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Address Line | 7053 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1712
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Country | US
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Telephone | 646-431-3097
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Fax | 718-770-7681
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPY PROVIDER
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Name | DR. ROLAND CASINO PAQUEO
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Credential | DPT
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Telephone | 646-431-3097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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