Healthcare Provider Details

I. General information

NPI: 1306064241
Provider Name (Legal Business Name): ALL COUNTY PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DURKEE LN
EAST PATCHOGUE NY
11772-5818
US

IV. Provider business mailing address

73 N OCEAN AVE STE 1
PATCHOGUE NY
11772-2011
US

V. Phone/Fax

Practice location:
  • Phone: 631-790-1700
  • Fax:
Mailing address:
  • Phone: 631-475-0700
  • Fax: 631-475-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number017275-1
License Number StateNY

VIII. Authorized Official

Name: JAMES VITO MAONE
Title or Position: PRESIDENT/OWNER
Credential: PT
Phone: 631-790-1700