Provider Demographics
NPI:1235674342
Name:39TH AVENUE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:39TH AVENUE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALARAGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-742-0221
Mailing Address - Street 1:103-18C 39AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-709-7583
Mailing Address - Fax:718-942-9341
Practice Address - Street 1:103-18C 39 AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-709-7583
Practice Address - Fax:718-942-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028369261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy