Provider Demographics
NPI:1508132804
Name:ROCKAWAY PARK PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ROCKAWAY PARK PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YEHUDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITVINTCHOUK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-318-8550
Mailing Address - Street 1:10322 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2739
Mailing Address - Country:US
Mailing Address - Phone:718-318-8550
Mailing Address - Fax:
Practice Address - Street 1:10322 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2739
Practice Address - Country:US
Practice Address - Phone:718-318-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty