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Organization
TRIFECTA PHYSICAL THERAPY PC
Active
Organization
TRIFECTA PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROMAN ALLAN SAMSON SOTELO PT (PT/OWNER)
(909) 992-2152
Entity
Organization
Contact information
Practice address
1070 HAVEMEYER AVE, BRONX, NY 10462-5310
(909) 992-2152
(570) 729-7242
Mailing address
1615 HOBART AVE APT 4A, BRONX, NY 10461-5245
(909) 992-2152
(570) 729-7242
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
028622
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295059061
IND NPI
—
01
—
1396254249
NPI TYPE II
—
Enumeration date
09/22/2017
Last updated
09/10/2018
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