Healthcare Provider Details

I. General information

NPI: 1104804376
Provider Name (Legal Business Name): HENRY G PURSLOW DPT MFS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 MAIN ST FARMINGDALE PHYSICAL THERAPY
FARMINGDALE NY
11735
US

IV. Provider business mailing address

326 MAIN ST FARMINGDALE PHYSICAL THERAPY
FARMINGDALE NY
11735
US

V. Phone/Fax

Practice location:
  • Phone: 516-293-0565
  • Fax: 516-293-1897
Mailing address:
  • Phone: 516-293-0565
  • Fax: 516-293-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0057601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: