Provider Demographics
NPI:1316514672
Name:HABITAT PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:HABITAT PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-450-6768
Mailing Address - Street 1:6613 BURNS ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3950
Mailing Address - Country:US
Mailing Address - Phone:646-752-3960
Mailing Address - Fax:
Practice Address - Street 1:6613 BURNS ST APT 2F
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3950
Practice Address - Country:US
Practice Address - Phone:646-752-3960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty