Provider Demographics
NPI:1033490628
Name:COREPOWER PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:COREPOWER PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:TATING
Authorized Official - Last Name:LOZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:347-334-2787
Mailing Address - Street 1:731 E 226TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4201
Mailing Address - Country:US
Mailing Address - Phone:347-334-2787
Mailing Address - Fax:888-552-2612
Practice Address - Street 1:731 E 226TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4201
Practice Address - Country:US
Practice Address - Phone:347-334-2787
Practice Address - Fax:888-552-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030266261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy