Provider Demographics
NPI:1144217415
Name:HEALING THERAPEUTICS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:HEALING THERAPEUTICS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JINETE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:914-939-3143
Mailing Address - Street 1:30 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4256
Mailing Address - Country:US
Mailing Address - Phone:914-939-3143
Mailing Address - Fax:914-939-3120
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4256
Practice Address - Country:US
Practice Address - Phone:914-939-3143
Practice Address - Fax:914-939-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024127-1225100000X
CT007634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03448928Medicaid
CTC03916Medicare PIN
NYG100073396Medicare PIN
NYQ6WTX1Medicare PIN