Provider Demographics
NPI:1942310123
Name:PHYSICAL THERAPY HOME & OFFICE SERVICES PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY HOME & OFFICE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-505-0243
Mailing Address - Street 1:4037 76TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1033
Mailing Address - Country:US
Mailing Address - Phone:718-505-0243
Mailing Address - Fax:718-505-0247
Practice Address - Street 1:4037 76TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1033
Practice Address - Country:US
Practice Address - Phone:718-505-0243
Practice Address - Fax:718-505-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-06-26
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
NY21055AMedicare PIN