Provider Demographics
NPI:1518315274
Name:PHOENIX PHYSICAL THERAPY REHABILITATION, PLLC
Entity Type:Organization
Organization Name:PHOENIX PHYSICAL THERAPY REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHET
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-733-1916
Mailing Address - Street 1:7510 4TH AVE
Mailing Address - Street 2:STE# 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3244
Mailing Address - Country:US
Mailing Address - Phone:347-733-1916
Mailing Address - Fax:929-292-2329
Practice Address - Street 1:7510 4TH AVE
Practice Address - Street 2:STE# 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3244
Practice Address - Country:US
Practice Address - Phone:347-733-1916
Practice Address - Fax:929-292-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037286225100000X
NY035548225100000X
NY037502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty