Healthcare Provider Details

I. General information

NPI: 1811050818
Provider Name (Legal Business Name): ACHIEVE PHYSICAL THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 BELLMORE AVE
NORTH BELLMORE NY
11710-5526
US

IV. Provider business mailing address

1651 BELLMORE AVE
NORTH BELLMORE NY
11710-5526
US

V. Phone/Fax

Practice location:
  • Phone: 516-781-1085
  • Fax: 516-781-1013
Mailing address:
  • Phone: 516-781-1085
  • Fax: 516-781-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015585-1
License Number StateNY

VIII. Authorized Official

Name: MR. JONATHAN ADAM VENEGAAS
Title or Position: PHYSICAL THERAPIST OWNER
Credential: P.T.
Phone: 516-781-1085