Healthcare Provider Details

I. General information

NPI: 1912294430
Provider Name (Legal Business Name): PHYSICAL THERAPY REHAB PLUS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROUTE 112 SUITE 6
CORAM NY
11727-2300
US

IV. Provider business mailing address

1970 ROUTE 112 SUITE 6
CORAM NY
11727-2300
US

V. Phone/Fax

Practice location:
  • Phone: 631-476-4600
  • Fax: 631-476-8236
Mailing address:
  • Phone: 631-476-4600
  • Fax: 631-476-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number032930-1
License Number StateNY

VIII. Authorized Official

Name: DENNIS PATRICK SALL
Title or Position: PRESIDENT
Credential: DPT
Phone: 631-476-4600