Provider Demographics
NPI:1710404850
Name:PHYSICAL THERAPY UNLIMITED
Entity type:Organization
Organization Name:PHYSICAL THERAPY UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HODA
Authorized Official - Middle Name:
Authorized Official - Last Name:AREF
Authorized Official - Suffix:
Authorized Official - Credentials:PT,MHS
Authorized Official - Phone:646-302-4406
Mailing Address - Street 1:684 OCEAN TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4538
Mailing Address - Country:US
Mailing Address - Phone:646-302-4406
Mailing Address - Fax:800-722-4260
Practice Address - Street 1:684 OCEAN TERRACE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301
Practice Address - Country:US
Practice Address - Phone:646-302-4406
Practice Address - Fax:800-722-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017097-1305R00000X
017097-1305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538499371Medicaid