Provider Demographics
NPI:1720751084
Name:THERAPEUTIC J8 REHAB PT PC
Entity type:Organization
Organization Name:THERAPEUTIC J8 REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNEMMA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-255-6152
Mailing Address - Street 1:8604 96TH ST APT A6
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1751
Mailing Address - Country:US
Mailing Address - Phone:347-255-6152
Mailing Address - Fax:888-502-9368
Practice Address - Street 1:8604 96TH ST APT A6
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1751
Practice Address - Country:US
Practice Address - Phone:347-255-6152
Practice Address - Fax:888-502-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty