Provider Demographics
NPI:1538330790
Name:TND PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:TND PHYSICAL THERAPY P.C.
Other - Org Name:PARK AVENUE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/CO-OWNER/SEC/TRE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:585-798-4344
Mailing Address - Street 1:711 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1036
Mailing Address - Country:US
Mailing Address - Phone:585-798-4344
Mailing Address - Fax:585-798-0439
Practice Address - Street 1:711 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1036
Practice Address - Country:US
Practice Address - Phone:585-798-4344
Practice Address - Fax:585-798-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1003OtherMEDICARE GROUP PRACTICE