Provider Demographics
NPI:1619132230
Name:THERADYNAMICS PHYSICAL THERAPY REHABILITATION PC
Entity Type:Organization
Organization Name:THERADYNAMICS PHYSICAL THERAPY REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTIGUL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-414-3497
Mailing Address - Street 1:280 W 231ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3940
Mailing Address - Country:US
Mailing Address - Phone:718-514-6120
Mailing Address - Fax:347-326-8899
Practice Address - Street 1:280 W 231ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3940
Practice Address - Country:US
Practice Address - Phone:718-514-6120
Practice Address - Fax:347-326-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQIW771Medicare PIN