Provider Demographics
NPI:1366689200
Name:PREMIERE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:PREMIERE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAOUF
Authorized Official - Middle Name:
Authorized Official - Last Name:AKL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-758-4520
Mailing Address - Street 1:174 BAY 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-0000
Mailing Address - Country:US
Mailing Address - Phone:718-758-4520
Mailing Address - Fax:
Practice Address - Street 1:56 ONDERDONK RD
Practice Address - Street 2:
Practice Address - City:WARICK
Practice Address - State:NY
Practice Address - Zip Code:10990
Practice Address - Country:US
Practice Address - Phone:718-758-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty