Provider Demographics
NPI:1184088577
Name:REHABWISE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:REHABWISE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OLARIO
Authorized Official - Last Name:GALLANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PCS, CSCS
Authorized Official - Phone:917-669-8104
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-0372
Mailing Address - Country:US
Mailing Address - Phone:917-669-8104
Mailing Address - Fax:
Practice Address - Street 1:347 E 14TH ST APT 4R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4234
Practice Address - Country:US
Practice Address - Phone:917-669-8104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024305-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency