Healthcare Provider Details

I. General information

NPI: 1891100699
Provider Name (Legal Business Name): SL PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTHERN PKWY W
PLAINVIEW NY
11803-1933
US

IV. Provider business mailing address

140 NORTHERN PKWY W
PLAINVIEW NY
11803-1933
US

V. Phone/Fax

Practice location:
  • Phone: 516-557-9564
  • Fax:
Mailing address:
  • Phone: 516-557-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number029590
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. SCOTT EVAN LIPTZIN
Title or Position: PRESIDENT
Credential: DPT
Phone: 516-557-9564