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Organization
NY PROFORM PHYSICAL THERAPY PC
Active
Organization
NY PROFORM PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM HANNA PT (OWNER)
(718) 618-0052
Entity
Organization
Contact information
Practice address
3350 WHITE PLAINS RD, BRONX, NY 10467-5701
(718) 618-0052
Mailing address
9522 63RD RD, REGO PARK, NY 11374-1142
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025663
STATE LICENSE
NY
Enumeration date
10/18/2019
Last updated
10/18/2019
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