Provider Demographics
NPI:1245069384
Name:OPULENT PHYSICAL THERAPY
Entity type:Organization
Organization Name:OPULENT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEIKA
Authorized Official - Middle Name:TIFFANY
Authorized Official - Last Name:HECKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-873-6304
Mailing Address - Street 1:84 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-3925
Mailing Address - Country:US
Mailing Address - Phone:516-763-0046
Mailing Address - Fax:
Practice Address - Street 1:9602 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4813
Practice Address - Country:US
Practice Address - Phone:917-873-6304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy