Provider Demographics
NPI:1982202024
Name:INTEGRATED PT2 PLLC
Entity Type:Organization
Organization Name:INTEGRATED PT2 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-520-1708
Mailing Address - Street 1:4720 CENTER BLVD APT 3006
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5648
Mailing Address - Country:US
Mailing Address - Phone:917-520-1708
Mailing Address - Fax:212-223-0198
Practice Address - Street 1:4720 CENTER BLVD APT 3006
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5648
Practice Address - Country:US
Practice Address - Phone:917-520-1708
Practice Address - Fax:212-223-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033417OtherLICENSE