Healthcare Provider Details

I. General information

NPI: 1235689738
Provider Name (Legal Business Name): ANDY PAKTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PALM RD
BAY SHORE NY
11706-6710
US

IV. Provider business mailing address

7 PALM RD
BAY SHORE NY
11706-6710
US

V. Phone/Fax

Practice location:
  • Phone: 773-750-7980
  • Fax:
Mailing address:
  • Phone: 773-750-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: