Provider Demographics
NPI:1215149513
Name:THERADYNAMICS PHYSICAL REHABILITATION
Entity type:Organization
Organization Name:THERADYNAMICS PHYSICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-548-1212
Mailing Address - Street 1:3166 BAINBRIDGE AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-3922
Mailing Address - Country:US
Mailing Address - Phone:718-548-1212
Mailing Address - Fax:718-548-1900
Practice Address - Street 1:3166 BAINBRIDGE AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3922
Practice Address - Country:US
Practice Address - Phone:718-548-1212
Practice Address - Fax:718-548-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty