Provider Demographics
NPI:1851568752
Name:CUTTING EDGE PHYSICAL THERAPY & WELLNESS INC
Entity Type:Organization
Organization Name:CUTTING EDGE PHYSICAL THERAPY & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:ADELIONE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-360-1697
Mailing Address - Street 1:1624 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1713
Mailing Address - Country:US
Mailing Address - Phone:718-360-1697
Mailing Address - Fax:
Practice Address - Street 1:1624 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1713
Practice Address - Country:US
Practice Address - Phone:718-360-1697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029404302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization