Organization
SHINING STAR PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MYRA RANADA LABIAL MS PT (OWNER)
(347) 392-8515
Entity
Organization
Contact information
Practice address
1700 GREAT NECK RD, COPIAGUE, NY 11726-2723
(631) 608-8700
Mailing address
18501 HILLSIDE AVE APT 1C, JAMAICA, NY 11432-4800
(347) 392-8515
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
029064-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0290641
LISCENCE
NY
Enumeration date
11/17/2017
Last updated
11/17/2017
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