Provider Demographics
NPI:1568909174
Name:SMALL WONDERS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:SMALL WONDERS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:ADELINE
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-772-6889
Mailing Address - Street 1:45 PONDFIELD RD W
Mailing Address - Street 2:APT. 2K
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2955
Mailing Address - Country:US
Mailing Address - Phone:914-772-6889
Mailing Address - Fax:
Practice Address - Street 1:45 PONDFIELD RD W
Practice Address - Street 2:APT. 2K
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2955
Practice Address - Country:US
Practice Address - Phone:914-772-6889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013271-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency