Provider Demographics
NPI:1053614776
Name:FLUSHING PHYSICAL THERAPY REHAB SERVIES PC
Entity type:Organization
Organization Name:FLUSHING PHYSICAL THERAPY REHAB SERVIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-886-0556
Mailing Address - Street 1:13101 39TH AVE STE E4
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4420
Mailing Address - Country:US
Mailing Address - Phone:718-886-0556
Mailing Address - Fax:
Practice Address - Street 1:13101 39TH AVE STE E4
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4420
Practice Address - Country:US
Practice Address - Phone:718-886-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1851607352OtherNPI