Healthcare Provider Details

I. General information

NPI: 1093101925
Provider Name (Legal Business Name): PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 TOMPKINS AVE
PLEASANTVILLE NY
10570-3144
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 914-495-3655
  • Fax: 914-495-3651
Mailing address:
  • Phone: 516-321-2400
  • Fax: 516-321-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HELEN AGRELO
Title or Position: SENIOR VP, ADMIN OPERATIONS
Credential:
Phone: 516-321-2400