Provider Demographics
NPI:1619199742
Name:ST.CATHERINE REHAB P.T, P.C
Entity Type:Organization
Organization Name:ST.CATHERINE REHAB P.T, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:917-609-4373
Mailing Address - Street 1:9309 91ST AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2745
Mailing Address - Country:US
Mailing Address - Phone:917-609-4373
Mailing Address - Fax:
Practice Address - Street 1:9309 91ST AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2745
Practice Address - Country:US
Practice Address - Phone:917-609-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty