Basic Information
| Provider Information | |||||||||
| NPI: | 1912996141 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER PHYSICAL THERAPY AND WELLNESS, PC | ||||||||
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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: | 170 E 77TH ST | ||||||||
| Address2: | PROF. UNIT 2 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100751912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122495332 | ||||||||
| FaxNumber: | 2122499539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 08/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | TATTA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2122495332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.