=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881309938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAPHENE PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2023
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 BROADWAY RM 630
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10006-3075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-588-0082
-----------------------------------------------------
Fax | 347-644-2747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 BROADWAY RM 630
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10006-3075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-588-0082
-----------------------------------------------------
Fax | 347-644-2747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DI CHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-588-0082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------