Provider Demographics
NPI:1942672381
Name:SENIOR CARE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SENIOR CARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-634-0397
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3717
Mailing Address - Country:US
Mailing Address - Phone:845-634-0397
Mailing Address - Fax:845-634-0754
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3717
Practice Address - Country:US
Practice Address - Phone:845-634-0397
Practice Address - Fax:845-634-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty