Provider Demographics
NPI:1851754857
Name:JAMES PIERRE-GLAUDE PHYSICAL THERAPY AND ATHLETIC TRAINING SVCS, P.C.
Entity Type:Organization
Organization Name:JAMES PIERRE-GLAUDE PHYSICAL THERAPY AND ATHLETIC TRAINING SVCS, P.C.
Other - Org Name:JAMES PIERRE-GLAUDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:PIERRE-GLAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, CSCS
Authorized Official - Phone:347-280-6548
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-0676
Mailing Address - Country:US
Mailing Address - Phone:347-280-6548
Mailing Address - Fax:
Practice Address - Street 1:62 LAKE AVE S STE C
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1094
Practice Address - Country:US
Practice Address - Phone:631-584-8783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477833432Medicare UPIN