Organization
PHYSIO REHAB PT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MENNATALLAH IBRAHIM (OWNER)
(646) 384-3095
Entity
Organization
Contact information
Practice address
14843 HILLSIDE AVE, JAMAICA, NY 11435-3330
(646) 384-3095
Mailing address
165 WESTWOOD DR APT 180, WESTBURY, NY 11590-1628
(646) 384-3095
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/02/2023
Last updated
10/02/2023
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