Provider Demographics
NPI:1447397518
Name:RIDGE ADVANCED PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:RIDGE ADVANCED PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-748-0864
Mailing Address - Street 1:152 72ND ST
Mailing Address - Street 2:APT 4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2063
Mailing Address - Country:US
Mailing Address - Phone:917-345-2043
Mailing Address - Fax:
Practice Address - Street 1:482 78TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3404
Practice Address - Country:US
Practice Address - Phone:718-748-0864
Practice Address - Fax:718-748-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty