Provider Demographics
NPI:1023546207
Name:GROWING UP PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:GROWING UP PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:917-582-4396
Mailing Address - Street 1:38 CAPRICORN LN
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-5112
Mailing Address - Country:US
Mailing Address - Phone:917-582-4396
Mailing Address - Fax:845-694-8903
Practice Address - Street 1:38 CAPRICORN LN
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-5112
Practice Address - Country:US
Practice Address - Phone:917-582-4396
Practice Address - Fax:845-694-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023141252Y00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy