Provider Demographics
NPI:1275398265
Name:BROOKLYN BODY WORKS PHYSICAL THERAPY - NORTHSIDE
Entity Type:Organization
Organization Name:BROOKLYN BODY WORKS PHYSICAL THERAPY - NORTHSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:NOLIVOS RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-340-3345
Mailing Address - Street 1:101 N 10TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-1910
Mailing Address - Country:US
Mailing Address - Phone:718-702-6105
Mailing Address - Fax:718-702-8659
Practice Address - Street 1:101 N 10TH ST APT 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1910
Practice Address - Country:US
Practice Address - Phone:718-702-6105
Practice Address - Fax:718-702-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty