Healthcare Provider Details

I. General information

NPI: 1417564253
Provider Name (Legal Business Name): SUFFOLK PHYSICAL THERAPY & CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 WALT WHITMAN RD
MELVILLE NY
11747-2212
US

IV. Provider business mailing address

PO BOX 1359
MELVILLE NY
11747-0308
US

V. Phone/Fax

Practice location:
  • Phone: 631-646-2256
  • Fax: 631-249-1793
Mailing address:
  • Phone: 631-646-2256
  • Fax: 631-249-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS F DOW
Title or Position: MANAGING MEMBER
Credential:
Phone: 631-249-0011