Provider Demographics
NPI:1497974067
Name:APOLLO PHYSICAL THERAPY & PHYSICAL THERAPIST ASSISTANT, PLLC
Entity Type:Organization
Organization Name:APOLLO PHYSICAL THERAPY & PHYSICAL THERAPIST ASSISTANT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:PENNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:917-493-9600
Mailing Address - Street 1:304 W 117TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1573
Mailing Address - Country:US
Mailing Address - Phone:917-493-9600
Mailing Address - Fax:917-493-2078
Practice Address - Street 1:304 W 117TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1573
Practice Address - Country:US
Practice Address - Phone:917-493-9600
Practice Address - Fax:917-493-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23023690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty