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General NPI Number Information
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NPI Number | 1881047223
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Entity Type | Organization
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Legal Business Name | ISLAND REHAB PT OT PLLC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 242 NATICK ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-1626
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Country | US
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Telephone | 718-354-0457
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Fax |
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Provider Business Mailing Address
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Address Line | 242 NATICK ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-1626
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Country | US
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Telephone | 718-354-0457
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YVONNE TARZIA MORANO
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Credential |
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Telephone | 718-354-0457
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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 | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 005711
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License Number State | NY
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