Provider Demographics
NPI:1912604828
Name:INNOVATIVE PHYSICAL THERAPEUTICS
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:646-258-1194
Mailing Address - Street 1:2808 35TH ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4628
Mailing Address - Country:US
Mailing Address - Phone:646-258-1194
Mailing Address - Fax:646-398-7532
Practice Address - Street 1:114 E 72ND ST PH B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4274
Practice Address - Country:US
Practice Address - Phone:646-398-7486
Practice Address - Fax:646-398-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty