Provider Demographics
NPI:1043762370
Name:J.R PHYSICAL THERAPY AND PERFORMANCE, PLLC
Entity type:Organization
Organization Name:J.R PHYSICAL THERAPY AND PERFORMANCE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-628-3006
Mailing Address - Street 1:450 N STATE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1451
Mailing Address - Country:US
Mailing Address - Phone:914-488-5763
Mailing Address - Fax:914-455-0217
Practice Address - Street 1:450 N STATE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF
Practice Address - State:NY
Practice Address - Zip Code:10510-1451
Practice Address - Country:US
Practice Address - Phone:914-488-5763
Practice Address - Fax:914-455-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 0382542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1316350861Medicare UPIN