Provider Demographics
NPI:1295831261
Name:PELVIC MUSCLE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:PELVIC MUSCLE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:GUTTA SONDHEIMER
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-367-6069
Mailing Address - Street 1:34 BACON RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1503
Mailing Address - Country:US
Mailing Address - Phone:516-367-6069
Mailing Address - Fax:
Practice Address - Street 1:300 OLD COUNTRY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-367-6069
Practice Address - Fax:516-876-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002673-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY811010OtherACN, UNITED HEALTH CARE
NYA523322OtherOSFORD HEALTH PLANS
NY811010OtherMANAGED PHYSICAL NETWORK
NYQ23781Medicare PIN