Provider Demographics
NPI:1528358082
Name:873 RT 45 PHYSICAL THERAPY
Entity Type:Organization
Organization Name:873 RT 45 PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:845-354-7779
Mailing Address - Street 1:873 ROUTE 45
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1106
Mailing Address - Country:US
Mailing Address - Phone:845-354-7779
Mailing Address - Fax:845-354-7780
Practice Address - Street 1:873 ROUTE 45
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1106
Practice Address - Country:US
Practice Address - Phone:845-354-7779
Practice Address - Fax:845-354-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty