Provider Demographics
NPI:1134654049
Name:WQG PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:WQG PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:QUIMBA
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-850-8700
Mailing Address - Street 1:87-60 125TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:718-850-8700
Mailing Address - Fax:718-850-8705
Practice Address - Street 1:87-60 125TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-850-8700
Practice Address - Fax:718-850-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty