Provider Demographics
NPI:1558941328
Name:BODY HACK HIGH PERFORMANCE PT PLLC
Entity Type:Organization
Organization Name:BODY HACK HIGH PERFORMANCE PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:HUMBERTO
Authorized Official - Last Name:ZORRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-238-3090
Mailing Address - Street 1:9972 66TH RD APT 1T
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4440
Mailing Address - Country:US
Mailing Address - Phone:917-733-3795
Mailing Address - Fax:
Practice Address - Street 1:1042 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5819
Practice Address - Country:US
Practice Address - Phone:718-433-9909
Practice Address - Fax:718-433-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty