Healthcare Provider Details

I. General information

NPI: 1902932932
Provider Name (Legal Business Name): TOR ERIC NIELSEN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LEEDS BLVD
FARMINGVILLE NY
11738-1147
US

IV. Provider business mailing address

35 LEEDS BLVD
FARMINGVILLE NY
11738-1147
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-4032
  • Fax: 631-698-4032
Mailing address:
  • Phone: 631-698-4032
  • Fax: 631-698-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number011726-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: