Provider Demographics
NPI:1932852241
Name:EMMANUEL PHYSICAL THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:EMMANUEL PHYSICAL THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGIELA MARIE
Authorized Official - Middle Name:GRANJA
Authorized Official - Last Name:AURELIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:917-742-0908
Mailing Address - Street 1:5875 NIGHT WIND CIR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-6475
Mailing Address - Country:US
Mailing Address - Phone:917-742-0908
Mailing Address - Fax:
Practice Address - Street 1:5875 NIGHT WIND CIR
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-6475
Practice Address - Country:US
Practice Address - Phone:917-742-0908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty