Provider Demographics
NPI:1750471124
Name:THERA DYNAMIC PHYSICAL THERAPY P.C
Entity Type:Organization
Organization Name:THERA DYNAMIC PHYSICAL THERAPY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE-ZEL MAY
Authorized Official - Middle Name:CARINGAL
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-494-5684
Mailing Address - Street 1:1443 28TH AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3663
Mailing Address - Country:US
Mailing Address - Phone:718-939-4166
Mailing Address - Fax:347-732-9011
Practice Address - Street 1:7922 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1801
Practice Address - Country:US
Practice Address - Phone:347-494-5684
Practice Address - Fax:347-494-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025591-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02837832Medicaid
NYPH0434OtherELDER PLAN
NY2766209OtherUNITED HEALTHCARE
NYP4059437OtherOXFORD FREEDOM
NYOP025591OtherMETROPLUS
NY1263296POtherEMBLEM HEALTH
NY1760591465-01OtherVILLAGE CARE
NY01941401OtherEMPIRE BCBS HEALTHPLUS
NYPT025591-A85OtherHEALTHFIRST
NY82ADC1OtherEMPIRE BCBS
NY841087OtherOPTUM HEALTH