| Organization Name: | FRESH POND PHYSICAL THERAPY, P.C |
| NPI Number: | 1508844036 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNY TAN (BILLING & COLLECTION DEPT. HEAD) |
| Mailing Address: | 6805 Fresh Pond Rd Ridgewood |
| State: | NY US |
| Postal Code: | 113855200 |
| Phone Number: | 7184562545 |
| Fax Number: | 7185596784 |
| NPI Enumeration Date: | 01/04/2006 |
| NPI Last Update Date: | 05/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 015401 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |