Organization
FOUR SQUARE PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AL MANJOORSA PT (PRESIDENT)
(347) 968-8304
Entity
Organization
Contact information
Practice address
8411 QUEENS BLVD, ELMHURST, NY 11373-3098
(929) 522-0841
(929) 522-0843
Mailing address
8411 QUEENS BLVD, ELMHURST, NY 11373-3098
(929) 522-0841
(929) 522-0843
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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