Provider Demographics
NPI: | 1750556510 |
---|---|
Name: | JM PHYSICAL THERAPY, PC |
Entity type: | Organization |
Organization Name: | JM PHYSICAL THERAPY, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR OF PHYSICAL THERAPY |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JACK |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | MANTIONE |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | DPT, CSCS |
Authorized Official - Phone: | 212-334-7441 |
Mailing Address - Street 1: | 55 WHITE ST APT 5A |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10013-3580 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-334-7441 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 55 WHITE ST APT 5A |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10013-3580 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-334-7441 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-04-23 |
Last Update Date: | 2008-04-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |