Provider Demographics
NPI:1043610579
Name:CORONA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:CORONA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:914-309-9564
Mailing Address - Street 1:10318 39TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10318 39TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2302
Practice Address - Country:US
Practice Address - Phone:718-205-1513
Practice Address - Fax:646-304-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty