Organization
JADE PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARICEL DE VERA (PT)
(347) 993-8251
Entity
Organization
Contact information
Practice address
557 OAK ST, COPIAGUE, NY 11726-3215
(631) 464-4700
Mailing address
557 OAK ST, COPIAGUE, NY 11726-3215
(631) 464-4700
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
NY
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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