Provider Demographics
NPI:1386915643
Name:WISDOM PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:WISDOM PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HATEM
Authorized Official - Middle Name:EL-SAID
Authorized Official - Last Name:ABOU-HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-480-6794
Mailing Address - Street 1:200 BAY 49TH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7202
Mailing Address - Country:US
Mailing Address - Phone:718-480-6794
Mailing Address - Fax:
Practice Address - Street 1:200 BAY 49TH ST
Practice Address - Street 2:STE 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-7202
Practice Address - Country:US
Practice Address - Phone:718-480-6794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty