Provider Demographics
NPI:1609556190
Name:EXTEND PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:EXTEND PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA RAMANA REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JALAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, DPT
Authorized Official - Phone:845-293-2599
Mailing Address - Street 1:39 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1358
Mailing Address - Country:US
Mailing Address - Phone:845-293-2599
Mailing Address - Fax:
Practice Address - Street 1:158 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2327
Practice Address - Country:US
Practice Address - Phone:845-293-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty