Provider Demographics
NPI:1629219894
Name:MAROVEN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MAROVEN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:BELLAFLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-830-0187
Mailing Address - Street 1:6254 97TH PL
Mailing Address - Street 2:# 60
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6254 97TH PL
Practice Address - Street 2:# 60
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1346
Practice Address - Country:US
Practice Address - Phone:718-830-0187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty