Provider Demographics
NPI:1184281537
Name:PROMET PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:PROMET PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-554-6610
Mailing Address - Street 1:7119 80TH ST STE 8210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7733
Mailing Address - Country:US
Mailing Address - Phone:718-554-6610
Mailing Address - Fax:718-360-4908
Practice Address - Street 1:444 COMMUNITY DRIVE
Practice Address - Street 2:SUITE 103 105
Practice Address - City:MANHASSETT
Practice Address - State:NY
Practice Address - Zip Code:11030-3820
Practice Address - Country:US
Practice Address - Phone:516-365-3344
Practice Address - Fax:516-365-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty