Provider Demographics
NPI:1972843449
Name:SYCAMORE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SYCAMORE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-708-6853
Mailing Address - Street 1:3050 CORLEAR AVE
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5180
Mailing Address - Country:US
Mailing Address - Phone:718-708-6853
Mailing Address - Fax:718-708-6855
Practice Address - Street 1:3050 CORLEAR AVE
Practice Address - Street 2:SUITE 102A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5180
Practice Address - Country:US
Practice Address - Phone:718-708-6853
Practice Address - Fax:718-708-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021983225100000X
NY022885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty