| NPI | 1790420966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKY CERVANTES Authorized Official/Provider 845-553-4607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 111N00000X Chiropractor |
| 225X00000X Occupational Therapist | |
| 261Q00000X | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2022-05-03 |