Provider Demographics
NPI:1003372939
Name:JA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:JA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH EDWIN
Authorized Official - Middle Name:VILLACORTE
Authorized Official - Last Name:ABRENICA
Authorized Official - Suffix:
Authorized Official - Credentials:BSPT
Authorized Official - Phone:850-832-9535
Mailing Address - Street 1:22164 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1930
Mailing Address - Country:US
Mailing Address - Phone:850-832-9535
Mailing Address - Fax:
Practice Address - Street 1:2799 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5015
Practice Address - Country:US
Practice Address - Phone:850-832-9535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty