Provider Demographics
NPI:1366505562
Name:INTERACTIVE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:INTERACTIVE PHYSICAL THERAPY PLLC
Other - Org Name:INTERACTIVE PHYSICAL THERAPY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMMEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MIRANDO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-527-0698
Mailing Address - Street 1:13906 SPRINGFIELD BLVD
Mailing Address - Street 2:# 1 B
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2633
Mailing Address - Country:US
Mailing Address - Phone:718-527-0698
Mailing Address - Fax:718-527-0698
Practice Address - Street 1:13906 SPRINGFIELD BLVD
Practice Address - Street 2:# 1 B
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11413-2633
Practice Address - Country:US
Practice Address - Phone:718-527-0698
Practice Address - Fax:718-527-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health