Basic Information
| Provider Information | |||||||||
| NPI: | 1023787009 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METRO SPORTS PHYSICAL THERAPY 48TH STREET, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 WATERSIDE PLZ APT 15J | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100102623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178871525 | ||||||||
| FaxNumber: | 2126828753 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 E 54TH ST STE 304 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100224854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592882 | ||||||||
| FaxNumber: | 2127592996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2021 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | REDINGTON | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9178871525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.