Organization
BAYSIDE REHAB PT PC
Active
Organization
BAYSIDE REHAB PT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIEVIC BALAAG EBORA FERNANDO PT, DPT (MANAGER)
(347) 777-9707
Entity
Organization
Contact information
Practice address
20801 NORTHERN BLVD STE 3, BAYSIDE, NY 11361-3120
(347) 777-9707
(332) 777-1842
Mailing address
20801 NORTHERN BLVD STE 3, BAYSIDE, NY 11361-3120
(347) 777-9707
(332) 777-1842
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
02/24/2020
Last updated
02/24/2020
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