Provider Demographics
NPI:1780217091
Name:RED CORE PTPTA AND REHABILITATION PLLC
Entity Type:Organization
Organization Name:RED CORE PTPTA AND REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-509-9888
Mailing Address - Street 1:PO BOX 780173
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-0173
Mailing Address - Country:US
Mailing Address - Phone:718-509-9888
Mailing Address - Fax:718-509-6144
Practice Address - Street 1:418 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3136
Practice Address - Country:US
Practice Address - Phone:718-509-9888
Practice Address - Fax:718-509-6144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED CORE PTPTA AND REHABILITATION PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty