OrganizationCore Physical Therapy & Sport Rehabilitation PcPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address259 Jefferson Blvd, Staten Island, NY 10312-3001(718) 356-2919PECOS EnrollmentBased on the most recent information from CMS, provider Core Physical Therapy & Sport Rehabilitation Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1306979075Provider TypeOrganizationFull NameCore Physical Therapy & Sport Rehabilitation PcSubpartNoEnumeration Date3/13/2007Last Updated2/23/2024Contact InformationPractice LocationPractice Address259 Jefferson Blvd, Staten Island, NY 10312-3001Phone(718) 356-2919FaxUnlisted FaxMailing LocationMailing Address259 Jefferson Blvd, Staten Island, NY 10312-3001Phone(718) 356-2919FaxUnlisted FaxAuthorized OfficialNamePacchiano, Mark Anthony (Owner)Phone(719) 356-2919Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense021520-1New York