Provider Demographics
NPI:1548775356
Name:EVERBRIGHT PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:EVERBRIGHT PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHUQIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:QI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-563-8610
Mailing Address - Street 1:7211 AUSTIN STREET
Mailing Address - Street 2:MB#194
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5354
Mailing Address - Country:US
Mailing Address - Phone:917-563-8610
Mailing Address - Fax:347-710-8806
Practice Address - Street 1:10714 71ST RD FL 1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4719
Practice Address - Country:US
Practice Address - Phone:718-755-2999
Practice Address - Fax:347-710-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty