Provider Demographics
NPI:1568494300
Name:PHYSICAL THERAPY DOCTOR,P.C
Entity Type:Organization
Organization Name:PHYSICAL THERAPY DOCTOR,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MOREA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-747-2019
Mailing Address - Street 1:1303 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1200
Mailing Address - Country:US
Mailing Address - Phone:718-747-2019
Mailing Address - Fax:718-767-6944
Practice Address - Street 1:1303 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1200
Practice Address - Country:US
Practice Address - Phone:718-747-2019
Practice Address - Fax:718-767-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty