Provider Demographics
NPI:1548242407
Name:SANTI F DIFRANCO DBA QUEENSLINE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SANTI F DIFRANCO DBA QUEENSLINE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WAAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:718-848-9100
Mailing Address - Street 1:7506 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1034
Mailing Address - Country:US
Mailing Address - Phone:718-848-9100
Mailing Address - Fax:718-848-1114
Practice Address - Street 1:7506 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1034
Practice Address - Country:US
Practice Address - Phone:718-848-9100
Practice Address - Fax:718-848-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003824OtherLICENSE