Provider Demographics
NPI:1720862402
Name:ALZA PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:ALZA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:ALZATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-806-8610
Mailing Address - Street 1:35-21 81ST ST APT 4K
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5071
Mailing Address - Country:US
Mailing Address - Phone:929-900-6127
Mailing Address - Fax:
Practice Address - Street 1:35-21 81ST ST APT 4K
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5071
Practice Address - Country:US
Practice Address - Phone:929-900-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty