BLC Physical Therapy PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

019468 Issued in NY

Legal business name

BLC PHYSICAL THERAPY PC

Practice address

320 Post Ave Ste 100
Westbury, NY 11590-2258

Phone

(631) 839-4059

NPI assigned

Mar 14, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leila Hisole Ceballos, PT,DPTNPI 1932247590

Title

Co Owner

Phone

(631) 839-4059

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leila Montefrio Hisole Ceballos, BSPT

  • Physical Therapist
  • Deer Park, NY
  • NPI 1932247590
  NPD (past) Authorized official
• Bienvenido Poncardas Ceballos Jr., BSPT

  • Physical Therapist
  • Westbury, NY
  • NPI 1558409110
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457913600000",
    "number": "1255792552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MONMOUTH ST",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117292514",
            "telephone_number": "631-839-4059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 POST AVE STE 100",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115902258",
            "telephone_number": "631-839-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLC PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-14",
        "last_updated": "2016-03-14",
        "status": "A",
        "authorized_official_last_name": "HISOLE CEBALLOS",
        "authorized_official_first_name": "LEILA",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "631-839-4059",
        "authorized_official_credential": "PT,DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "019468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Westbury, NY
• Providers in Westbury, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.