Provider Demographics
NPI:1679708549
Name:EAST WEST KINETICS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EAST WEST KINETICS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MA. ALMA
Authorized Official - Middle Name:GUBOC
Authorized Official - Last Name:RUFANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-886-6677
Mailing Address - Street 1:3511 FARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2826
Mailing Address - Country:US
Mailing Address - Phone:718-886-6677
Mailing Address - Fax:718-886-1413
Practice Address - Street 1:3511 FARRINGTON ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2826
Practice Address - Country:US
Practice Address - Phone:718-886-6677
Practice Address - Fax:718-886-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021194261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy