Healthcare Provider Details

I. General information

NPI: 1831418359
Provider Name (Legal Business Name): PEDIATRIC PHYSICAL AND OCCUPATIONAL THERAPY OF HUDSON VALLEY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ROUTE 59
NANUET NY
10954-2918
US

IV. Provider business mailing address

160 E ROUTE 59
NANUET NY
10954-2918
US

V. Phone/Fax

Practice location:
  • Phone: 845-362-7877
  • Fax: 845-362-7788
Mailing address:
  • Phone: 845-362-7877
  • Fax: 845-362-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number010962-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number009738-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA H FULLER
Title or Position: PRESIDENT
Credential: PT
Phone: 845-362-7787