Provider Demographics
NPI:1902021058
Name:BODY IN BALANCE PHYSICAL THERAPY ,PC
Entity Type:Organization
Organization Name:BODY IN BALANCE PHYSICAL THERAPY ,PC
Other - Org Name:MILLENNIUM PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODOSIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAMONITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-932-1269
Mailing Address - Street 1:3063 38TH ST FL B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3803
Mailing Address - Country:US
Mailing Address - Phone:718-932-1269
Mailing Address - Fax:718-932-0198
Practice Address - Street 1:8616 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5135
Practice Address - Country:US
Practice Address - Phone:718-833-4656
Practice Address - Fax:718-833-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06775Medicare ID - Type UnspecifiedPHYSICAL THERAPY