Provider Demographics
NPI:1508340985
Name:ARISTA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ARISTA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-764-3977
Mailing Address - Street 1:106 LOCKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2052
Mailing Address - Country:US
Mailing Address - Phone:347-764-3977
Mailing Address - Fax:
Practice Address - Street 1:106 LOCKMAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2052
Practice Address - Country:US
Practice Address - Phone:347-764-3977
Practice Address - Fax:347-695-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty