Organization
BROADWAY PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOBILE PRUDENCE SIBANDA PHYSICAL THERAPIST (OWNER)
(718) 448-4500
Entity
Organization
Contact information
Practice address
289 BROADWAY, STATEN ISLAND, NY 10310-2004
(718) 448-4500
(718) 448-4506
Mailing address
289 BROADWAY, STATEN ISLAND, NY 10310-2004
(718) 448-4500
(718) 448-4506
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
016088
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02647758
—
NY
Enumeration date
08/08/2006
Last updated
12/11/2023
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