Provider Demographics
NPI:1316318041
Name:REHAB FOCUS PHYSICAL THERAPY,PC
Entity type:Organization
Organization Name:REHAB FOCUS PHYSICAL THERAPY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OTHILIA
Authorized Official - Middle Name:TENORIO
Authorized Official - Last Name:JUMAGDAO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-533-8588
Mailing Address - Street 1:86-35 QUEENS BLVD.
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4408
Mailing Address - Country:US
Mailing Address - Phone:718-533-8588
Mailing Address - Fax:718-533-1249
Practice Address - Street 1:86-35 QUEENS BLVD.
Practice Address - Street 2:SUITE 1B
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4408
Practice Address - Country:US
Practice Address - Phone:718-533-8588
Practice Address - Fax:718-533-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032691OtherLICENSE NUMBER