Provider Demographics
NPI:1205358025
Name:BIG CITY PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:BIG CITY PHYSICAL THERAPY, PLLC
Other - Org Name:BIG CITY PHYSICAL THERAPY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-945-0805
Mailing Address - Street 1:3202 MORLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1906
Mailing Address - Country:US
Mailing Address - Phone:917-945-0805
Mailing Address - Fax:
Practice Address - Street 1:3202 MORLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1906
Practice Address - Country:US
Practice Address - Phone:917-945-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035024225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03506916Medicaid
MA1043521396OtherTYPE I NPI