Provider Demographics
NPI:1609149582
Name:43RD ST. PHYSICAL MEDICINE AND REHABILITATION, PLLC
Entity type:Organization
Organization Name:43RD ST. PHYSICAL MEDICINE AND REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LABONETE
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:213-304-0502
Mailing Address - Street 1:311 W 43RD ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6413
Mailing Address - Country:US
Mailing Address - Phone:212-315-1412
Mailing Address - Fax:212-315-1442
Practice Address - Street 1:311 W 43RD ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6413
Practice Address - Country:US
Practice Address - Phone:212-315-1412
Practice Address - Fax:212-315-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033599-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty