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Organization
FRESH POND PHYSICAL THERAPY ASTORIA, P.C.
Active
Organization
FRESH POND PHYSICAL THERAPY ASTORIA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZA TAN DPT, PT (CEO)
(718) 456-2543
Entity
Organization
Contact information
Practice address
4618 BROADWAY, ASTORIA, NY 11103-1628
(718) 274-4200
(718) 559-6784
Mailing address
6805 FRESH POND RD, RIDGEWOOD, NY 11385-5200
(718) 456-2545
(718) 559-6784
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
015401-1
NY
Other
Enumeration date
04/09/2012
Last updated
05/20/2016
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