Provider Demographics
NPI:1952519084
Name:THERAMAX REHABILITATION & SPORTS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:THERAMAX REHABILITATION & SPORTS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT , OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MCKILLOP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-693-6377
Mailing Address - Street 1:631 SAW MILL RIVER RD
Mailing Address - Street 2:SUITW 1N
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2146
Mailing Address - Country:US
Mailing Address - Phone:914-693-6377
Mailing Address - Fax:914-693-6384
Practice Address - Street 1:631 SAW MILL RIVER RD
Practice Address - Street 2:SUITE 1N
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2146
Practice Address - Country:US
Practice Address - Phone:914-693-6377
Practice Address - Fax:914-693-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018137-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ6W2E1Medicare ID - Type Unspecified