Provider Demographics
NPI:1891184511
Name:THERADYNAMICS REHAB MGMT., LLC
Entity Type:Organization
Organization Name:THERADYNAMICS REHAB MGMT., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:347-610-0427
Mailing Address - Street 1:225 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2054
Mailing Address - Country:US
Mailing Address - Phone:516-422-7840
Mailing Address - Fax:
Practice Address - Street 1:225 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2054
Practice Address - Country:US
Practice Address - Phone:516-422-7840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty