Provider Demographics
NPI:1609346774
Name:OTHNIEL PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:OTHNIEL PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMEZANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-334-5552
Mailing Address - Street 1:444 MIDDLENECK RD
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:GREATNECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:917-334-5552
Mailing Address - Fax:516-570-6282
Practice Address - Street 1:444 MIDDLENECK RD
Practice Address - Street 2:SUITE 1H
Practice Address - City:GREATNECK
Practice Address - State:NY
Practice Address - Zip Code:11023
Practice Address - Country:US
Practice Address - Phone:917-334-5552
Practice Address - Fax:516-570-6282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OTHNIEL PHYSICAL THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty