Provider Demographics
NPI:1346667789
Name:WHOLE BODY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WHOLE BODY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DPT
Authorized Official - Prefix:
Authorized Official - First Name:ADESOLA
Authorized Official - Middle Name:ABIGAIL
Authorized Official - Last Name:TELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-351-5869
Mailing Address - Street 1:353A MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1104
Mailing Address - Country:US
Mailing Address - Phone:347-351-5869
Mailing Address - Fax:347-405-9975
Practice Address - Street 1:4319 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3101
Practice Address - Country:US
Practice Address - Phone:347-351-5869
Practice Address - Fax:347-405-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028818-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty