Provider Demographics
NPI:1003231754
Name:TRI PHYSICAL THERAPY,PC
Entity Type:Organization
Organization Name:TRI PHYSICAL THERAPY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FYODOROVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-998-9880
Mailing Address - Street 1:2279 CONEY ISLAND AVE
Mailing Address - Street 2:SUITE #2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3337
Mailing Address - Country:US
Mailing Address - Phone:718-998-9880
Mailing Address - Fax:718-998-9891
Practice Address - Street 1:2279 CONEY ISLAND AVE
Practice Address - Street 2:SUITE #2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3337
Practice Address - Country:US
Practice Address - Phone:718-998-9890
Practice Address - Fax:718-998-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty