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Organization
PRO FORM PHYSICAL THERAPY PC
Active
Organization
PRO FORM PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM HANNA PT (OWNER/PHYSICAL THERAPIST)
(917) 545-9249
Entity
Organization
Contact information
Practice address
1973 UNIVERSITY AVE, BRONX, NY 10453-4404
(718) 618-0052
(718) 534-4135
Mailing address
95-22 63RD ROAD, SUITE 412, REGO PARK, NY 11374-1142
(718) 618-0052
(718) 534-4135
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
021421
NY
174400000X
Specialist
Primary
025663
NY
Other
Enumeration date
07/08/2013
Last updated
03/01/2016
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