Organization
PHYSIO DEVELOPMENT PT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MENNATALLAH IBRAHIM (OWNER)
(646) 384-3095
Entity
Organization
Contact information
Practice address
2270 GRAND AVE, BALDWIN, NY 11510-3163
(646) 384-3095
Mailing address
165 WESTWOOD DR APT 180, WESTBURY, NY 11590-1628
(646) 384-3095
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
—
—
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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