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Organization
MITRA PHYSICAL THERAPY
Active
Organization
MITRA PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THEODERICK I MITRA PT (PRESIDENT)
(516) 451-3427
Entity
Organization
Contact information
Practice address
24312 73RD AVE FL 2, DOUGLASTON, NY 11362-2320
(516) 451-3427
(347) 235-0932
Mailing address
24312 73RD AVE FL 2, DOUGLASTON, NY 11362-2320
(516) 451-3427
(347) 235-0932
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
018279
NY
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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