Provider Demographics
NPI:1518785344
Name:THE AZURE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:THE AZURE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAFEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:929-899-3055
Mailing Address - Street 1:11508 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3909
Mailing Address - Country:US
Mailing Address - Phone:929-899-3055
Mailing Address - Fax:
Practice Address - Street 1:11508 150TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3909
Practice Address - Country:US
Practice Address - Phone:929-899-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty