Provider Demographics
NPI:1427278076
Name:C.P. PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:C.P. PHYSICAL THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-797-8345
Mailing Address - Street 1:176-25 UNION TPKE
Mailing Address - Street 2:SUITE 278
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-835-4199
Mailing Address - Fax:718-835-2989
Practice Address - Street 1:97-01 101ST AVENUE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416
Practice Address - Country:US
Practice Address - Phone:718-835-4199
Practice Address - Fax:718-835-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1265592810OtherNPI
NY06097GMedicare UPIN