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General NPI Number Information
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NPI Number | 1902290059
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Entity Type | Organization
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Legal Business Name | DREAM PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 923 5TH AVE APT. 7G
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City | NEW YORK
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State | NY
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Zip | 10021-2649
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Country | US
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Telephone | 212-500-0560
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Fax |
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Provider Business Mailing Address
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Address Line | 4334 32ND PL PENTHOUSE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-2307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA SHALOM
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Credential |
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Telephone | 212-500-0560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 036625
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License Number State | NY
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