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General NPI Number Information
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NPI Number | 1992102388
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Entity Type | Organization
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Legal Business Name | BIG STRIDES WIDE REACH OT, PT PLLC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 11940 METROPOLITAN AVE SUITE 105
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City | KEW GARDENS
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State | NY
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Zip | 11415-2600
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Country | US
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Telephone | 718-880-1911
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Fax | 718-487-3425
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Provider Business Mailing Address
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Address Line | 11940 METROPOLITAN AVE SUITE 105
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City | KEW GARDENS
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State | NY
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Zip | 11415-2600
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Country | US
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Telephone | 718-880-1911
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Fax | 718-487-3425
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Authorized Official
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Title or Position | PT/MANAGING PARTNER
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Name | CHARMAINE MORCILLA
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Credential | PT
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Telephone | 718-880-1911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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