Provider Demographics
NPI:1164460879
Name:ADVANCED SPORTS, PHYSICAL & ORTHOPEDIC REHABILITATIVE THERAPY SERVICES
Entity type:Organization
Organization Name:ADVANCED SPORTS, PHYSICAL & ORTHOPEDIC REHABILITATIVE THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-820-9300
Mailing Address - Street 1:163 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3045
Mailing Address - Country:US
Mailing Address - Phone:516-616-1111
Mailing Address - Fax:516-616-1112
Practice Address - Street 1:17660 UNION TPKE
Practice Address - Street 2:SUITE 195
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1531
Practice Address - Country:US
Practice Address - Phone:718-820-9300
Practice Address - Fax:718-820-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy