Healthcare Provider Details

I. General information

NPI: 1417862293
Provider Name (Legal Business Name): ANETRELLA PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W MERRICK RD
FREEPORT NY
11520-3709
US

IV. Provider business mailing address

138 HENRIETTA AVE
OCEANSIDE NY
11572-5226
US

V. Phone/Fax

Practice location:
  • Phone: 516-208-7305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARYMIEL JOY ANETRELLA
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 646-286-5038