Healthcare Provider Details

I. General information

NPI: 1497041107
Provider Name (Legal Business Name): TOTAL THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OAKLAND HILLS DR
MOUNT SINAI NY
11766-3401
US

IV. Provider business mailing address

19 OAKLAND HILLS DR
MOUNT SINAI NY
11766-3401
US

V. Phone/Fax

Practice location:
  • Phone: 631-747-1909
  • Fax:
Mailing address:
  • Phone: 631-747-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number024104-1
License Number StateNY

VIII. Authorized Official

Name: MRS. SHABNAM N THANAWALA
Title or Position: PT
Credential: PT
Phone: 631-747-1909