Provider Demographics
NPI:1831868256
Name:REACTIVE PHYSICAL THERAPY & REHAB PC
Entity type:Organization
Organization Name:REACTIVE PHYSICAL THERAPY & REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPY PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:CASINO
Authorized Official - Last Name:PAQUEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-431-3097
Mailing Address - Street 1:7053 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1712
Mailing Address - Country:US
Mailing Address - Phone:646-431-3097
Mailing Address - Fax:718-770-7681
Practice Address - Street 1:7053 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1712
Practice Address - Country:US
Practice Address - Phone:646-431-3097
Practice Address - Fax:718-770-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty