Healthcare Provider Details

I. General information

NPI: 1578317202
Provider Name (Legal Business Name): ISLAND POWER PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BUCCANEER LN
EAST SETAUKET NY
11733-1806
US

IV. Provider business mailing address

4 BUCCANEER LN
EAST SETAUKET NY
11733-1806
US

V. Phone/Fax

Practice location:
  • Phone: 516-459-0395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELE AQUINO
Title or Position: CEO/PHYSICAL THERAPIST
Credential: DPT
Phone: 516-459-0395