=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912268319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAISE PHYSICAL THERAPY REHABILITATION SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2012
-----------------------------------------------------
Last Update Date | 04/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2088 MURRAY HILL ST
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-326-8225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2088 MURRAY HILL ST
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-326-8225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | OLUWATOYIN JOHN FADUGBA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 516-326-8225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 017495
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------