Provider Demographics
NPI:1881999191
Name:HUMAN PERFORMANCE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:HUMAN PERFORMANCE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-483-1434
Mailing Address - Street 1:209-80 18TH AVE
Mailing Address - Street 2:1A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360
Mailing Address - Country:US
Mailing Address - Phone:646-483-1434
Mailing Address - Fax:
Practice Address - Street 1:2104 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3965
Practice Address - Country:US
Practice Address - Phone:347-840-2858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty