Provider Demographics
NPI:1598302770
Name:MANUAL INTUITIVE PHYSICAL THERAPY & PHYSICAL THERAPY ASSISTANT PLLC
Entity Type:Organization
Organization Name:MANUAL INTUITIVE PHYSICAL THERAPY & PHYSICAL THERAPY ASSISTANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-269-7330
Mailing Address - Street 1:42 RICHMOND TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1909
Mailing Address - Country:US
Mailing Address - Phone:718-269-7330
Mailing Address - Fax:
Practice Address - Street 1:42 RICHMOND TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1909
Practice Address - Country:US
Practice Address - Phone:718-269-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy