Provider Demographics
NPI:1568907921
Name:QUEENS WELLNESS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:QUEENS WELLNESS PHYSICAL THERAPY PC
Other - Org Name:FYZICAL THERAPY & BALANCE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-463-6700
Mailing Address - Street 1:164-10 NORTHERN BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-463-6700
Mailing Address - Fax:718-463-6174
Practice Address - Street 1:164-10 NORTHERN BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-463-6700
Practice Address - Fax:718-463-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021153261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy