Provider Demographics
NPI:1871762682
Name:THERACARE & WELLNESS PHYSICAL THERAPY,P.C
Entity type:Organization
Organization Name:THERACARE & WELLNESS PHYSICAL THERAPY,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:MARTES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-925-9374
Mailing Address - Street 1:3109 NEWTOWN AVE
Mailing Address - Street 2:211
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3109 NEWTOWN AVE
Practice Address - Street 2:211
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1373
Practice Address - Country:US
Practice Address - Phone:718-728-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy