Basic Information
| Provider Information | |||||||||
| NPI: | 1104116094 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER PHYSICAL THERAPY AND WELLNESS PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PREMIER PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1536 3RD AVE | ||||||||
| Address2: | 5TH FL. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100282167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128612630 | ||||||||
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| Practice Location | |||||||||
| Address1: | 226 E 54TH ST | ||||||||
| Address2: | SUITE #304 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100224854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126962727 | ||||||||
| FaxNumber: | 2126964499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 01/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | TATTA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2126962727 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.