Provider Demographics
NPI:1649485772
Name:THERA EX ORTHOPEDIC & SPORTS PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:THERA EX ORTHOPEDIC & SPORTS PHYSICAL THERAPY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:ESTONILO
Authorized Official - Last Name:PLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-476-0951
Mailing Address - Street 1:4 TUCKAHOE RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-5319
Mailing Address - Country:US
Mailing Address - Phone:914-476-0951
Mailing Address - Fax:914-476-0948
Practice Address - Street 1:4 TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-5319
Practice Address - Country:US
Practice Address - Phone:914-476-0951
Practice Address - Fax:914-476-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ71411Medicare UPIN