Provider Demographics
NPI:1265730030
Name:COMPLETE BODY PHYSICAL THERAPY 1 PC
Entity type:Organization
Organization Name:COMPLETE BODY PHYSICAL THERAPY 1 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARTOSZ
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKICIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:212-248-3030
Mailing Address - Street 1:80 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2806
Mailing Address - Country:US
Mailing Address - Phone:212-248-3030
Mailing Address - Fax:212-248-3033
Practice Address - Street 1:22 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4204
Practice Address - Country:US
Practice Address - Phone:212-248-3030
Practice Address - Fax:212-248-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026282-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty