Provider Demographics
NPI:1770874182
Name:THERAPISTS 2 GO OCCUPATIONAL PHYSICAL & SPEECH LANGUAGE PATHOLOG
Entity type:Organization
Organization Name:THERAPISTS 2 GO OCCUPATIONAL PHYSICAL & SPEECH LANGUAGE PATHOLOG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-203-4170
Mailing Address - Street 1:18 E 116TH ST
Mailing Address - Street 2:1R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1041
Mailing Address - Country:US
Mailing Address - Phone:212-203-4170
Mailing Address - Fax:800-783-5909
Practice Address - Street 1:18 E 116TH ST
Practice Address - Street 2:1R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1041
Practice Address - Country:US
Practice Address - Phone:212-203-4170
Practice Address - Fax:800-783-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025953225100000X
NY012073235Z00000X
NY007477225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty