Provider Demographics
NPI:1396826020
Name:COMMUNITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COMMUNITY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-424-9531
Mailing Address - Street 1:6284 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3738
Mailing Address - Country:US
Mailing Address - Phone:718-424-9531
Mailing Address - Fax:718-424-2695
Practice Address - Street 1:6284 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3738
Practice Address - Country:US
Practice Address - Phone:718-424-9531
Practice Address - Fax:718-424-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0021592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYANC 1250OtherOXFORD PROVIDE NUMBER
NYQ24011OtherBC/BS PROVIDER NUMBER
NYANC 1250OtherOXFORD PROVIDE NUMBER