Basic Information
| Provider Information | |||||||||
| NPI: | 1053811000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIMELESS PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FORDHAM HILL OVAL APT 3D | ||||||||
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| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104688004 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 81 ELIZABETH ST STE 303 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100134729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122198987 | ||||||||
| FaxNumber: | 2122198982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2018 | ||||||||
| LastUpdateDate: | 02/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | BALDOVINO | ||||||||
| AuthorizedOfficialFirstName: | MITZY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2138803157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 030954 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.