Healthcare Provider Details

I. General information

NPI: 1629370846
Provider Name (Legal Business Name): .PHYSICAL THERAPY FOR THE 21ST CENTURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BRENTWOOD RD
BAY SHORE NY
11706-8011
US

IV. Provider business mailing address

24 BRENTWOOD RD
BAY SHORE NY
11706-8011
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-8100
  • Fax: 631-665-2227
Mailing address:
  • Phone: 631-666-8100
  • Fax: 631-665-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: DEIDRE M. POSTUPACK
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 631-666-8100