Provider Demographics
NPI:1891724720
Name:PROFITNESS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PROFITNESS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:BEDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-327-0600
Mailing Address - Street 1:171 E 84TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2000
Mailing Address - Country:US
Mailing Address - Phone:212-327-0600
Mailing Address - Fax:212-327-0776
Practice Address - Street 1:171 E 84TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2000
Practice Address - Country:US
Practice Address - Phone:212-327-0600
Practice Address - Fax:212-327-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q2WVW2Medicare PIN