Provider Demographics
NPI:1447789409
Name:EMORY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:EMORY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-405-8340
Mailing Address - Street 1:1350 E MAIN ST UNIT 41
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-7502
Mailing Address - Country:US
Mailing Address - Phone:917-405-8340
Mailing Address - Fax:
Practice Address - Street 1:106-01 LIBERTY AV
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1810
Practice Address - Country:US
Practice Address - Phone:917-405-8340
Practice Address - Fax:347-427-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty