Provider Demographics
NPI:1376051102
Name:MITU PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MITU PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPT
Authorized Official - Prefix:
Authorized Official - First Name:NAGAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAIDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:718-205-7710
Mailing Address - Street 1:3728 75TH ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6426
Mailing Address - Country:US
Mailing Address - Phone:718-205-7710
Mailing Address - Fax:
Practice Address - Street 1:421 78TH ST STE C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3447
Practice Address - Country:US
Practice Address - Phone:718-205-7710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0184751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty