Provider Demographics
NPI:1548825623
Name:THERAPRO WELLNESS PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:THERAPRO WELLNESS PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:PAQUEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-431-3097
Mailing Address - Street 1:9245 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4624
Mailing Address - Country:US
Mailing Address - Phone:646-431-3097
Mailing Address - Fax:
Practice Address - Street 1:8931 161ST ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6140
Practice Address - Country:US
Practice Address - Phone:646-431-3097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty