Provider Demographics
NPI:1578845137
Name:TRICARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:TRICARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-234-8800
Mailing Address - Street 1:460 OLD POST RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-1070
Mailing Address - Country:US
Mailing Address - Phone:914-234-8800
Mailing Address - Fax:914-234-8803
Practice Address - Street 1:460 OLD POST RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1070
Practice Address - Country:US
Practice Address - Phone:914-234-8800
Practice Address - Fax:914-234-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty