Provider Demographics
NPI:1427661065
Name:ACTIVE UNITED CARE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:ACTIVE UNITED CARE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWDROS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-710-6965
Mailing Address - Street 1:22 GLENN DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2104
Mailing Address - Country:US
Mailing Address - Phone:516-710-6965
Mailing Address - Fax:
Practice Address - Street 1:17119 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4548
Practice Address - Country:US
Practice Address - Phone:516-710-6965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty