Provider Demographics
NPI:1609013820
Name:REHAB ONE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:REHAB ONE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-696-8896
Mailing Address - Street 1:162-04 JAMAICA AVE.
Mailing Address - Street 2:5FLR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-206-4420
Mailing Address - Fax:718-206-4423
Practice Address - Street 1:162-04 JAMAICA AVE.
Practice Address - Street 2:5FLR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-206-4420
Practice Address - Fax:718-206-4423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHAB ONE PHYSICAL THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0W4R1Medicare PIN