Provider Demographics
NPI:1275234742
Name:DEEPER WELL PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:DEEPER WELL PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:OPOKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:917-586-3894
Mailing Address - Street 1:433 7TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7310
Mailing Address - Country:US
Mailing Address - Phone:917-586-3894
Mailing Address - Fax:
Practice Address - Street 1:433 7TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7310
Practice Address - Country:US
Practice Address - Phone:917-586-3894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty