Healthcare Provider Details

I. General information

NPI: 1679518617
Provider Name (Legal Business Name): CHRISTINA M PANETTA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 VETERANS MEMORIAL HWY
RONKONKOMA NY
11779-7660
US

IV. Provider business mailing address

3385 VETERANS MEMORIAL HWY STE 1
RONKONKOMA NY
11779-7660
US

V. Phone/Fax

Practice location:
  • Phone: 631-676-3111
  • Fax: 631-676-3116
Mailing address:
  • Phone: 631-665-4560
  • Fax: 631-665-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9077
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number009077-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: