Provider Demographics
NPI:1083043061
Name:JPM PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:JPM PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:SABINIANO
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANGGURAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:718-764-6669
Mailing Address - Street 1:9316 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1528
Mailing Address - Country:US
Mailing Address - Phone:718-764-6669
Mailing Address - Fax:718-835-5505
Practice Address - Street 1:9316 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1528
Practice Address - Country:US
Practice Address - Phone:718-764-6669
Practice Address - Fax:718-835-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031423-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy