Basic Information
| Provider Information | |||||||||
| NPI: | 1023492170 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C. | ||||||||
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| OtherOrganizationName: | PRO FIT | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2142 UTOPIA PKWY | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113574142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188196800 | ||||||||
| FaxNumber: | 3478419109 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 E 77TH ST | ||||||||
| Address2: | UNIT2 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100751912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122495332 | ||||||||
| FaxNumber: | 2122499539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2015 | ||||||||
| LastUpdateDate: | 07/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | PABELLON | ||||||||
| AuthorizedOfficialFirstName: | LETICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF ADMINISTRATIVE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5163212447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.