Provider Demographics
NPI:1770654568
Name:ELITE AQUATIC PHYSICAL THERAPY AND REHABILITATION, P.C.
Entity Type:Organization
Organization Name:ELITE AQUATIC PHYSICAL THERAPY AND REHABILITATION, P.C.
Other - Org Name:SINDO MANUAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL RAY
Authorized Official - Middle Name:DE GRACIA
Authorized Official - Last Name:SINDO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CERTMDT
Authorized Official - Phone:718-996-1854
Mailing Address - Street 1:128-130 BRIGHTON BEACH AVENUE
Mailing Address - Street 2:SUITE 1, 3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8372
Mailing Address - Country:US
Mailing Address - Phone:718-996-1854
Mailing Address - Fax:718-996-1694
Practice Address - Street 1:128-130 BRIGHTON BEACH AVENUE
Practice Address - Street 2:SUITE 1, 3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8372
Practice Address - Country:US
Practice Address - Phone:718-996-1854
Practice Address - Fax:718-996-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2517079OtherUNITED HEALTHCARE
NY4473457OtherCIGNA
NY02657674Medicaid
P3740765OtherOXFORD
NY0136977OtherGHI
NY03000005OtherHEALTHNET
NY182224OtherELDERPLAN
NY4473457OtherCIGNA
NY182224OtherELDERPLAN
NY=========OtherMAGNACARE
NY182224OtherELDERPLAN