Provider Demographics
NPI:1932471612
Name:PHYSIOLOGIC CHIROPRACTIC & PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PHYSIOLOGIC CHIROPRACTIC & PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GEHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-260-1000
Mailing Address - Street 1:157 REMSEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4321
Mailing Address - Country:US
Mailing Address - Phone:718-260-1000
Mailing Address - Fax:718-260-0072
Practice Address - Street 1:157 REMSEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4321
Practice Address - Country:US
Practice Address - Phone:718-260-1000
Practice Address - Fax:718-260-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXD010420-1111N00000X
NY0081641225100000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty