Provider Demographics
NPI:1699185413
Name:PHYSICAL THERAPY ULTRA PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ULTRA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANIANTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-301-5893
Mailing Address - Street 1:150 W 51ST ST
Mailing Address - Street 2:APT 1123
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6836
Mailing Address - Country:US
Mailing Address - Phone:646-301-5893
Mailing Address - Fax:
Practice Address - Street 1:150 W 51ST ST
Practice Address - Street 2:APT 1123
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6836
Practice Address - Country:US
Practice Address - Phone:646-301-5893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0286932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty