Provider Demographics
NPI:1306221577
Name:PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.
Other - Org Name:PRO FIT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP OF ADMINISTRATIVE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PABELLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-321-2447
Mailing Address - Street 1:2142 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4142
Mailing Address - Country:US
Mailing Address - Phone:516-321-2447
Mailing Address - Fax:914-517-2848
Practice Address - Street 1:36 OLD KINGS HWY S
Practice Address - Street 2:SUITE 110
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4552
Practice Address - Country:US
Practice Address - Phone:203-202-9889
Practice Address - Fax:203-202-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty