Provider Demographics
NPI:1700112026
Name:MANAGED CARE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:MANAGED CARE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:MANEUL
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-861-6610
Mailing Address - Street 1:3756 61ST ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2538
Mailing Address - Country:US
Mailing Address - Phone:917-861-6610
Mailing Address - Fax:
Practice Address - Street 1:3756 61ST ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2538
Practice Address - Country:US
Practice Address - Phone:917-861-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 029932251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health