Provider Demographics
NPI:1235643776
Name:REFORM PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:REFORM PHYSICAL THERAPY, PLLC
Other - Org Name:REFORM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:212-739-9237
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-0975
Mailing Address - Country:US
Mailing Address - Phone:212-739-9237
Mailing Address - Fax:
Practice Address - Street 1:650 BROADWAY FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2315
Practice Address - Country:US
Practice Address - Phone:212-739-9237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty