Provider Demographics
NPI:1376523001
Name:PHYSIOTHERAPY REHABILITATION ORGANIZATION, P.C.
Entity Type:Organization
Organization Name:PHYSIOTHERAPY REHABILITATION ORGANIZATION, P.C.
Other - Org Name:PRO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-213-8866
Mailing Address - Street 1:50 LEXINGTON AVE
Mailing Address - Street 2:STE LL3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2935
Mailing Address - Country:US
Mailing Address - Phone:212-213-8866
Mailing Address - Fax:212-213-8868
Practice Address - Street 1:50 LEXINGTON AVE
Practice Address - Street 2:STELL3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2935
Practice Address - Country:US
Practice Address - Phone:212-213-8866
Practice Address - Fax:212-213-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005525-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5359-1Medicare ID - Type Unspecified