Provider Demographics
NPI:1679829998
Name:JM PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:JM PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-538-4047
Mailing Address - Street 1:112 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8514
Mailing Address - Country:US
Mailing Address - Phone:212-867-1777
Mailing Address - Fax:
Practice Address - Street 1:112 E 61ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8514
Practice Address - Country:US
Practice Address - Phone:212-867-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023347261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023347OtherNY LICENSE