Provider Demographics
NPI:1710284559
Name:CT PHYSICAL THERAPY CARE, P.C.
Entity Type:Organization
Organization Name:CT PHYSICAL THERAPY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER JAY
Authorized Official - Middle Name:REGANIT
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:347-989-7979
Mailing Address - Street 1:4310 52ND ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4542
Mailing Address - Country:US
Mailing Address - Phone:347-989-7979
Mailing Address - Fax:718-255-1288
Practice Address - Street 1:4310 52ND ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4542
Practice Address - Country:US
Practice Address - Phone:347-989-7979
Practice Address - Fax:718-255-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3257756Medicaid