Provider Demographics
NPI:1679845762
Name:873 RT 45 SUITE 102 PHYSICAL THERAPY,PLLC
Entity Type:Organization
Organization Name:873 RT 45 SUITE 102 PHYSICAL THERAPY,PLLC
Other - Org Name:ROCKLAND RECOVERY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-354-7779
Mailing Address - Street 1:873 ROUTE 45 SUITE 102
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-354-7779
Mailing Address - Fax:845-354-7780
Practice Address - Street 1:873 ROUTE 45 STE 102
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1106
Practice Address - Country:US
Practice Address - Phone:845-354-7779
Practice Address - Fax:845-354-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty