Provider Demographics
NPI:1336971266
Name:SHARE A SMILE PHYSICAL THERPAY PC
Entity type:Organization
Organization Name:SHARE A SMILE PHYSICAL THERPAY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANOOP
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-707-6970
Mailing Address - Street 1:524 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5526
Mailing Address - Country:US
Mailing Address - Phone:929-422-3880
Mailing Address - Fax:718-732-1307
Practice Address - Street 1:39-07 PRINCE ST 5A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5357
Practice Address - Country:US
Practice Address - Phone:929-422-3880
Practice Address - Fax:718-732-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Multi-Specialty