Provider Demographics
NPI:1356689509
Name:CORE ALLIANCE PHYSICAL THERAPY,PLLC
Entity Type:Organization
Organization Name:CORE ALLIANCE PHYSICAL THERAPY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:7188-866-0088
Mailing Address - Street 1:14809 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4346
Mailing Address - Country:US
Mailing Address - Phone:718-886-4188
Mailing Address - Fax:718-886-6088
Practice Address - Street 1:14809 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4346
Practice Address - Country:US
Practice Address - Phone:718-886-4188
Practice Address - Fax:718-886-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty