Basic Information
| Provider Information | |||||||||
| NPI: | 1861636557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RECOVERY PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1385 BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | LARCHMONT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105383933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143151800 | ||||||||
| FaxNumber: | 9143151799 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 7TH AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100184878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128403030 | ||||||||
| FaxNumber: | 2128403063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2009 | ||||||||
| LastUpdateDate: | 04/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | DESMOND | ||||||||
| AuthorizedOfficialFirstName: | GERARD | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2129539494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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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.