Provider Demographics
NPI:1184898793
Name:THERACARE & WELLNESS PT PC
Entity type:Organization
Organization Name:THERACARE & WELLNESS PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANIBAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-728-2277
Mailing Address - Street 1:31-09 NEWTOWN AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:718-728-2277
Mailing Address - Fax:718-728-6945
Practice Address - Street 1:31-09 NEWTOWN AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-728-2277
Practice Address - Fax:718-728-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017574225100000X
NY014965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty