Provider Demographics
NPI:1689047326
Name:BEYOND BASICS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BEYOND BASICS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:LAMANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-354-2622
Mailing Address - Street 1:88 MAZUR PL
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3519
Mailing Address - Country:US
Mailing Address - Phone:201-873-8534
Mailing Address - Fax:
Practice Address - Street 1:110 E 42ND ST
Practice Address - Street 2:SUITE 1504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5611
Practice Address - Country:US
Practice Address - Phone:212-354-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039241302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization