Basic Information
| Provider Information | |||||||||
| NPI: | 1932437134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICCASS PHYSICAL THERAPY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 W 80TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100246301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125954500 | ||||||||
| FaxNumber: | 2125954578 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 W 80TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100246301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125954500 | ||||||||
| FaxNumber: | 2125954578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2009 | ||||||||
| LastUpdateDate: | 08/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHAMOUN | ||||||||
| AuthorizedOfficialFirstName: | JENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2125954500 | ||||||||
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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 | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.