Provider Demographics
NPI:1891144382
Name:OUTREACH MANUAL PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:OUTREACH MANUAL PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:HABLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-888-1727
Mailing Address - Street 1:8881 24TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6501
Mailing Address - Country:US
Mailing Address - Phone:929-888-1727
Mailing Address - Fax:
Practice Address - Street 1:8881 24TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6501
Practice Address - Country:US
Practice Address - Phone:929-888-1727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037478261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy