Provider Demographics
NPI:1003231754
Name:TRI PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:TRI PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FYODOROVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-998-9877
Mailing Address - Street 1:35 W END AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4869
Mailing Address - Country:US
Mailing Address - Phone:718-998-9877
Mailing Address - Fax:718-957-9008
Practice Address - Street 1:35 W END AVE STE C1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4869
Practice Address - Country:US
Practice Address - Phone:718-998-9877
Practice Address - Fax:718-957-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty