Provider Demographics
NPI:1023386091
Name:ANDORA PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:ANDORA PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMADIKA
Authorized Official - Middle Name:BIENTA
Authorized Official - Last Name:HOSPEDALES
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:917-642-5169
Mailing Address - Street 1:350 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1814
Mailing Address - Country:US
Mailing Address - Phone:917-642-5169
Mailing Address - Fax:
Practice Address - Street 1:350 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1814
Practice Address - Country:US
Practice Address - Phone:917-642-5169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024372-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1831343433OtherNPI