Provider Demographics
NPI:1790950822
Name:BODY ZONES ELITE PHYSICAL THERAPY PAS & FITNESS PLLC
Entity Type:Organization
Organization Name:BODY ZONES ELITE PHYSICAL THERAPY PAS & FITNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FERN
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:TOBACK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-581-8520
Mailing Address - Street 1:23 CLOVER LANE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-582-8520
Mailing Address - Fax:
Practice Address - Street 1:23 CLOVER LANE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-582-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty