Provider Demographics
NPI:1780952796
Name:BODY IN BALANCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:BODY IN BALANCE PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODOSIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAMONITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-932-1269
Mailing Address - Street 1:3063 38TH ST FL B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3803
Mailing Address - Country:US
Mailing Address - Phone:718-932-1269
Mailing Address - Fax:718-932-0198
Practice Address - Street 1:19413 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3032
Practice Address - Country:US
Practice Address - Phone:718-428-3500
Practice Address - Fax:718-428-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024817-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06775Medicare PIN