Provider Demographics
NPI:1902290059
Name:DREAM PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:DREAM PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-500-0560
Mailing Address - Street 1:4334 32ND PL
Mailing Address - Street 2:PENTHOUSE
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 5TH AVE
Practice Address - Street 2:APT. 7G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2649
Practice Address - Country:US
Practice Address - Phone:212-500-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036625261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy