Healthcare Provider Details

I. General information

NPI: 1922159359
Provider Name (Legal Business Name): PERFORM PHYSICAL THERAPY AND PILATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 06/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 LIDO BLVD
LIDO BEACH NY
11561-4833
US

IV. Provider business mailing address

141 LIDO BLVD
LIDO BEACH NY
11561-4833
US

V. Phone/Fax

Practice location:
  • Phone: 516-220-4177
  • Fax: 516-992-2282
Mailing address:
  • Phone: 516-220-4177
  • Fax: 516-992-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number013055
License Number StateNY

VIII. Authorized Official

Name: DR. MELINDA STOSKI
Title or Position: OWNER
Credential: PT, DPT,MS,OCS,CPI
Phone: 516-220-4177