Provider Demographics
NPI:1851757090
Name:HEALTHWAY REHABILITATION PT PC
Entity Type:Organization
Organization Name:HEALTHWAY REHABILITATION PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:CALUBAQUIB
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-213-2577
Mailing Address - Street 1:82-50 135TH STREET
Mailing Address - Street 2:APT6F
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:718-213-2577
Mailing Address - Fax:
Practice Address - Street 1:102-06 METROPOLITAN AVENUE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-674-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty