Provider Demographics
NPI:1912028671
Name:ASTORIA PHYSICAL THERAPY AND SPORTS REHABILITATION CENTER, PC
Entity Type:Organization
Organization Name:ASTORIA PHYSICAL THERAPY AND SPORTS REHABILITATION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLAND
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-325-7711
Mailing Address - Street 1:2120 EXCHANGE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3365
Mailing Address - Country:US
Mailing Address - Phone:503-325-7711
Mailing Address - Fax:
Practice Address - Street 1:2120 EXCHANGE ST STE 104
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3366
Practice Address - Country:US
Practice Address - Phone:503-325-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR424623-90261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy