MEDICARE: ACHIEVE WELLNESS PT OT PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	225XP0200X	Pediatric Occupational Therapist
3	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1467018291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVE WELLNESS PT OT PLLC

Provider Business Mailing Address
First Line	:	239 BOYLE RD
Second Line	:	STE 3
City	:	SELDEN
State	:	NY
Zip	:	11784-1955
Country	:	US
Telephone Number	:	631-290-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 BOYLE RD STE 3
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-1955
Country	:	US
Telephone Number	:	631-290-7400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIETTE DOHERTY
Credential	:	OT
Telephone Number	:	631-290-7400

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	12/26/2019

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