Healthcare Provider Details

I. General information

NPI: 1831554898
Provider Name (Legal Business Name): PPT THERAPIES OF WESTERN SUFFOLK, PT, OT, SLP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 VETERANS HWY SUITE 5
COMMACK NY
11725-3410
US

IV. Provider business mailing address

77 VETERANS HWY SUITE 5
COMMACK NY
11725-3410
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-4344
  • Fax: 631-499-4383
Mailing address:
  • Phone: 631-499-4344
  • Fax: 631-499-4383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KIM MUOLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-499-4344