Provider Demographics
NPI:1790837953
Name:BODY AND BALANCE PHYSICAL THERAPY,PC
Entity Type:Organization
Organization Name:BODY AND BALANCE PHYSICAL THERAPY,PC
Other - Org Name:MILLENNIUM PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODOSIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAMONITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-428-9369
Mailing Address - Street 1:22415 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2301
Mailing Address - Country:US
Mailing Address - Phone:646-577-5661
Mailing Address - Fax:
Practice Address - Street 1:19413 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3032
Practice Address - Country:US
Practice Address - Phone:718-428-9369
Practice Address - Fax:718-423-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62028308261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY62028308OtherLICENSE