Provider Demographics
NPI:1952673758
Name:THERA KIDS, PT PC
Entity Type:Organization
Organization Name:THERA KIDS, PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, DPT
Authorized Official - Phone:718-986-6563
Mailing Address - Street 1:2601 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2001
Mailing Address - Country:US
Mailing Address - Phone:718-986-6563
Mailing Address - Fax:718-368-1155
Practice Address - Street 1:2601 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2001
Practice Address - Country:US
Practice Address - Phone:718-986-6563
Practice Address - Fax:718-368-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023149252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency