Provider Demographics
NPI:1609288331
Name:DYNAMIC PHYSICAL THERAPY OF QUEENS PLLC
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY OF QUEENS PLLC
Other - Org Name:DYNAMIC PT OF QUEENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMNISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:914-309-9564
Mailing Address - Street 1:6248 80TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1323
Mailing Address - Country:US
Mailing Address - Phone:718-429-2888
Mailing Address - Fax:646-304-8252
Practice Address - Street 1:5718 WOODSIDE AVE
Practice Address - Street 2:2FLR SUITE#103
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3415
Practice Address - Country:US
Practice Address - Phone:718-205-0030
Practice Address - Fax:646-304-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy