Provider Demographics
NPI:1053811000
Name:TIMELESS PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:TIMELESS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MITZY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDOVINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:213-880-3157
Mailing Address - Street 1:1 FORDHAM HILL OVAL APT 3D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-8004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81 ELIZABETH ST STE 303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4729
Practice Address - Country:US
Practice Address - Phone:212-219-8987
Practice Address - Fax:212-219-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty