Provider Demographics
NPI:1154843555
Name:ORTHOPRO PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ORTHOPRO PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYANTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT OCS
Authorized Official - Phone:973-699-0599
Mailing Address - Street 1:402 E 74TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3935
Mailing Address - Country:US
Mailing Address - Phone:973-699-0599
Mailing Address - Fax:646-357-3577
Practice Address - Street 1:9 E 68TH ST STE B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4915
Practice Address - Country:US
Practice Address - Phone:646-389-6010
Practice Address - Fax:646-357-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036359-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty