Provider Demographics
NPI:1104203165
Name:COMPREHENSIVE ATLANTIC PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:COMPREHENSIVE ATLANTIC PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-884-2460
Mailing Address - Street 1:3424 KINGSBRIDGE AVE
Mailing Address - Street 2:STE 1H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4001
Mailing Address - Country:US
Mailing Address - Phone:718-884-2460
Mailing Address - Fax:888-543-7447
Practice Address - Street 1:3424 KINGSBRIDGE AVE
Practice Address - Street 2:STE 1H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4001
Practice Address - Country:US
Practice Address - Phone:718-884-2460
Practice Address - Fax:888-543-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy