Healthcare Provider Details

I. General information

NPI: 1053689323
Provider Name (Legal Business Name): SAGNELLA PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 1ST AVE
MORICHES NY
11955-1001
US

IV. Provider business mailing address

PO BOX 492
CENTER MORICHES NY
11934-0492
US

V. Phone/Fax

Practice location:
  • Phone: 631-566-2793
  • Fax: 631-320-0932
Mailing address:
  • Phone: 631-566-2793
  • Fax: 631-320-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012491
License Number StateNY

VIII. Authorized Official

Name: MR. ALBERT PETER SAGNELLA
Title or Position: OWNER
Credential: MAPT
Phone: 631-566-2793