Provider Demographics
NPI:1710361639
Name:ENERGETIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ENERGETIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-234-5689
Mailing Address - Street 1:279 W 117TH ST
Mailing Address - Street 2:APT 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2109
Mailing Address - Country:US
Mailing Address - Phone:646-234-5689
Mailing Address - Fax:
Practice Address - Street 1:279 W 117TH ST
Practice Address - Street 2:APT 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2109
Practice Address - Country:US
Practice Address - Phone:646-234-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy