Provider Demographics
NPI:1902166028
Name:ADEL PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ADEL PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADELAIDA
Authorized Official - Middle Name:MIJOS
Authorized Official - Last Name:LAGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-205-2992
Mailing Address - Street 1:13810 35TH AVE
Mailing Address - Street 2:#1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3402
Mailing Address - Country:US
Mailing Address - Phone:718-205-2992
Mailing Address - Fax:
Practice Address - Street 1:13810 35TH AVE
Practice Address - Street 2:#1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3402
Practice Address - Country:US
Practice Address - Phone:718-205-2992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031067-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty