Healthcare Provider Details

I. General information

NPI: 1164677514
Provider Name (Legal Business Name): DENISE UZICH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2008
Last Update Date: 11/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 SOUTHARD AVE
ROCKVILLE CENTRE NY
11570-2616
US

IV. Provider business mailing address

162 SOUTHARD AVE
ROCKVILLE CENTRE NY
11570-2616
US

V. Phone/Fax

Practice location:
  • Phone: 516-620-6719
  • Fax: 516-941-0793
Mailing address:
  • Phone: 516-620-6719
  • Fax: 516-941-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: