Provider Demographics
NPI:1154132025
Name:GOOD SHEPHERD REHAB PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:GOOD SHEPHERD REHAB PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:POLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-487-9348
Mailing Address - Street 1:9810 101ST AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2680
Mailing Address - Country:US
Mailing Address - Phone:803-487-9348
Mailing Address - Fax:
Practice Address - Street 1:3703 92ND ST FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7929
Practice Address - Country:US
Practice Address - Phone:718-424-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-18
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty