Provider Demographics
NPI:1265855290
Name:R2K PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:R2K PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:COBALLES
Authorized Official - Last Name:ABITONA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-257-8469
Mailing Address - Street 1:3222 56TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1917
Mailing Address - Country:US
Mailing Address - Phone:347-257-8469
Mailing Address - Fax:
Practice Address - Street 1:15031 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3927
Practice Address - Country:US
Practice Address - Phone:347-829-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty