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General NPI Number Information
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NPI Number | 1881999191
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Entity Type | Organization
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Legal Business Name | HUMAN PERFORMANCE PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 2104 FRANCIS LEWIS BLVD
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City | WHITESTONE
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State | NY
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Zip | 11357-3965
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Country | US
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Telephone | 347-840-2858
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Fax |
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Provider Business Mailing Address
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Address Line | 209-80 18TH AVE 1A
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City | BAYSIDE
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State | NY
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Zip | 11360
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Country | US
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Telephone | 646-483-1434
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JOSHUA GRAUER
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Credential | DPT
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Telephone | 646-483-1434
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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 | 029631
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License Number State | NY
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