Provider Demographics
NPI:1548382831
Name:STATION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STATION PHYSICAL THERAPY
Other - Org Name:MANHATTAN SPORTS & MANUAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:ANGELIQUE
Authorized Official - Last Name:HENAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-487-2495
Mailing Address - Street 1:10 E 33RD STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:646-487-2495
Mailing Address - Fax:646-487-2497
Practice Address - Street 1:10 E 33RD STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:646-487-2495
Practice Address - Fax:646-487-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0139731207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
186709POtherHIP
P2195022OtherOXFORD HEALTH
OA6161Medicare ID - Type Unspecified