Provider Demographics
NPI:1114552353
Name:WONDERFUL MOTION PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:WONDERFUL MOTION PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANILO SHANE
Authorized Official - Middle Name:DECASTRO
Authorized Official - Last Name:BADIOLA
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:347-465-0763
Mailing Address - Street 1:347 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2117
Mailing Address - Country:US
Mailing Address - Phone:347-465-0763
Mailing Address - Fax:
Practice Address - Street 1:347 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2117
Practice Address - Country:US
Practice Address - Phone:347-465-0763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy