Provider Demographics
NPI:1710426689
Name:INTEGRATED PHYSICAL THERAPY AND HEALTHCARE PC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY AND HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:212-226-6780
Mailing Address - Street 1:139 CENTRE ST FRNT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4564
Mailing Address - Country:US
Mailing Address - Phone:212-226-6780
Mailing Address - Fax:212-226-6299
Practice Address - Street 1:139 CENTRE ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4564
Practice Address - Country:US
Practice Address - Phone:212-226-6780
Practice Address - Fax:212-226-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025263OtherLICENSE