Healthcare Provider Details

I. General information

NPI: 1528033628
Provider Name (Legal Business Name): SEAFORD PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 MERRICK RD
SEAFORD NY
11783
US

IV. Provider business mailing address

4007 MERRICK RD
SEAFORD NY
11783
US

V. Phone/Fax

Practice location:
  • Phone: 516-783-3420
  • Fax: 516-783-6962
Mailing address:
  • Phone: 516-783-3420
  • Fax: 516-783-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8496
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID J DEGRASSI
Title or Position: OWNER PRESIDENT
Credential: PT
Phone: 516-783-3420