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General NPI Number Information
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NPI Number | 1881032084
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 8510 122ND ST
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City | KEW GARDENS
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State | NY
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Zip | 11415-3232
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Country | US
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Telephone | 718-501-0421
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Fax |
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Provider Business Mailing Address
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Address Line | 8510 122ND ST
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City | KEW GARDENS
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State | NY
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Zip | 11415-3232
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Country | US
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Telephone | 718-501-0421
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | VIRENDER JAIN
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Credential |
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Telephone | 917-715-7671
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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 | 031350-1
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License Number State | NY
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