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General NPI Number Information
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NPI Number | 1942780317
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Entity Type | Organization
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Legal Business Name | BORO WELLNESS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 4909 FORT HAMILTON PKWY
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City | BROOKLYN
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State | NY
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Zip | 11219-3386
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Country | US
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Telephone | 347-820-1495
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Fax |
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Provider Business Mailing Address
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Address Line | 4909 FORT HAMILTON PKWY STE A
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City | BROOKLYN
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State | NY
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Zip | 11219-3372
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Country | US
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Telephone | 347-820-1495
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. RONALD BUENAGUA RUSTIA
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Credential | PT
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Telephone | 347-820-1495
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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 | 022584
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License Number State | NY
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