Provider Demographics
NPI:1720350663
Name:CONCRETE PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:CONCRETE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:ABUAN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-690-6947
Mailing Address - Street 1:RR 4 BOX 4571
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-9372
Mailing Address - Country:US
Mailing Address - Phone:917-690-6947
Mailing Address - Fax:570-629-5549
Practice Address - Street 1:RR 4 BOX 4571
Practice Address - Street 2:
Practice Address - City:SAYLORSBURG
Practice Address - State:PA
Practice Address - Zip Code:18353-9372
Practice Address - Country:US
Practice Address - Phone:917-690-6947
Practice Address - Fax:570-629-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017905-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health