Healthcare Provider Details

I. General information

NPI: 1699036772
Provider Name (Legal Business Name): METRO THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LUCY CT
PATCHOGUE NY
11772-1425
US

IV. Provider business mailing address

8 LUCY CT
PATCHOGUE NY
11772-1425
US

V. Phone/Fax

Practice location:
  • Phone: 631-447-1649
  • Fax:
Mailing address:
  • Phone: 631-447-1649
  • Fax: 631-447-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. LARISSA AUDREY HUGHES
Title or Position: MS
Credential:
Phone: 631-447-1649