Provider Demographics
NPI:1215283064
Name:CREATIVITY REHABILITATION PHYSICAL THERAPY
Entity type:Organization
Organization Name:CREATIVITY REHABILITATION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:ASKARINAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-675-2919
Mailing Address - Street 1:955 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3611
Mailing Address - Country:US
Mailing Address - Phone:347-675-2919
Mailing Address - Fax:347-554-8202
Practice Address - Street 1:1648 E 14TH ST STE 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1175
Practice Address - Country:US
Practice Address - Phone:347-554-8201
Practice Address - Fax:347-554-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty