Healthcare Provider Details

I. General information

NPI: 1316417702
Provider Name (Legal Business Name): MICHELLE DOXSEE PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N OCEAN AVE
PATCHOGUE NY
11772-2016
US

IV. Provider business mailing address

24 DEWEY ST
SAYVILLE NY
11782-1302
US

V. Phone/Fax

Practice location:
  • Phone: 631-513-7398
  • Fax:
Mailing address:
  • Phone: 631-513-7398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier04-3848958
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerTAX ID

VIII. Authorized Official

Name: MICHELLE DOXSEE
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: PT
Phone: 631-513-7398