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General NPI Number Information
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NPI Number | 1891220968
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Entity Type | Organization
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Legal Business Name | MGH PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 14428 34TH AVE
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City | FLUSHING
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State | NY
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Zip | 11354-3127
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Country | US
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Telephone | 917-578-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 14428 34TH AVE
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City | FLUSHING
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State | NY
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Zip | 11354-3127
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Country | US
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Telephone | 917-578-3337
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARIOS HARITOS
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Credential | PT
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Telephone | 917-578-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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