Provider Demographics
NPI:1902447188
Name:COMMUNITY PHYSICAL THERAPY REHAB PT PC
Entity Type:Organization
Organization Name:COMMUNITY PHYSICAL THERAPY REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT PT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-337-7878
Mailing Address - Street 1:265 BEACH 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3625
Mailing Address - Country:US
Mailing Address - Phone:718-337-7878
Mailing Address - Fax:
Practice Address - Street 1:265 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3625
Practice Address - Country:US
Practice Address - Phone:718-337-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018065OtherLICENSE