Provider Demographics
NPI:1639477144
Name:PHYSICAL THERAPY AND WELLNESS CENTER
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-662-7532
Mailing Address - Street 1:8411 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3340
Mailing Address - Country:US
Mailing Address - Phone:718-331-2667
Mailing Address - Fax:
Practice Address - Street 1:8411 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3340
Practice Address - Country:US
Practice Address - Phone:718-331-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty