Big Strides Wide Reach OT, PT PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BIG STRIDES WIDE REACH OT, PT PLLC

Practice address

11940 Metropolitan Ave
Suite 105
Kew Gardens, NY 11415-2600

Phone

(718) 880-1911

Fax

(718) 487-3425

NPI assigned

Dec 1, 2014

Organization subpart

No

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

Authorized official

Name

Charmaine Morcilla, PT

Title

PT/Managing Partner

Phone

(718) 880-1911

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417392000000",
    "number": "1992102388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11940 METROPOLITAN AVE",
            "address_2": "SUITE 105",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114152600",
            "telephone_number": "718-880-1911",
            "fax_number": "718-487-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11940 METROPOLITAN AVE",
            "address_2": "SUITE 105",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114152600",
            "telephone_number": "718-880-1911",
            "fax_number": "718-487-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG STRIDES WIDE REACH OT, PT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-01",
        "last_updated": "2014-12-01",
        "status": "A",
        "authorized_official_last_name": "MORCILLA",
        "authorized_official_first_name": "CHARMAINE",
        "authorized_official_title_or_position": "PT/MANAGING PARTNER",
        "authorized_official_telephone_number": "718-880-1911",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2014; 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.