Provider Demographics
NPI:1356699482
Name:EV PHYSICAL THERAPY AND ACUPUNCTURE, PLLC
Entity type:Organization
Organization Name:EV PHYSICAL THERAPY AND ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLEZA VILLAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:347-909-7042
Mailing Address - Street 1:139 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5130
Mailing Address - Country:US
Mailing Address - Phone:347-909-7241
Mailing Address - Fax:347-909-7242
Practice Address - Street 1:6801 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5856
Practice Address - Country:US
Practice Address - Phone:347-909-7241
Practice Address - Fax:347-909-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty