Provider Demographics
NPI:1225223548
Name:TRINITY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:TRINITY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-279-5111
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-0966
Mailing Address - Country:US
Mailing Address - Phone:845-279-5111
Mailing Address - Fax:845-279-5121
Practice Address - Street 1:838 FAIR ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3085
Practice Address - Country:US
Practice Address - Phone:845-279-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023515302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL9981Medicare PIN
NYQ1W5R1Medicare UPIN