Provider Demographics
NPI:1104025410
Name:ADEPT PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:ADEPT PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY JOY
Authorized Official - Middle Name:ESPIRITU
Authorized Official - Last Name:CUBILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-529-4384
Mailing Address - Street 1:15928 92ND ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3122
Mailing Address - Country:US
Mailing Address - Phone:718-529-4384
Mailing Address - Fax:718-529-4384
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:718-529-4384
Practice Address - Fax:718-529-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020023261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020023OtherNEW YORK STATE LICENSE AS
NYWZVTQ1Medicare PIN