Provider Demographics
NPI:1891220968
Name:MGH PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MGH PHYSICAL THERAPY PC
Other - Org Name:MGH PHYSICAL THERAPY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARITOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-578-3337
Mailing Address - Street 1:14428 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3127
Mailing Address - Country:US
Mailing Address - Phone:917-578-3337
Mailing Address - Fax:
Practice Address - Street 1:14428 34TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3127
Practice Address - Country:US
Practice Address - Phone:917-578-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty