Provider Demographics
NPI:1881236362
Name:PHYSICAL THERAPY LAB
Entity type:Organization
Organization Name:PHYSICAL THERAPY LAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:914-772-5586
Mailing Address - Street 1:11 HILTON PL
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1206
Mailing Address - Country:US
Mailing Address - Phone:914-772-5586
Mailing Address - Fax:
Practice Address - Street 1:210 SUMMIT AVE STE B1
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1526
Practice Address - Country:US
Practice Address - Phone:201-683-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy