Healthcare Provider Details

I. General information

NPI: 1467018291
Provider Name (Legal Business Name): ACHIEVE WELLNESS PT OT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BOYLE RD STE 3
SELDEN NY
11784-1955
US

IV. Provider business mailing address

239 BOYLE RD STE 3
SELDEN NY
11784-1955
US

V. Phone/Fax

Practice location:
  • Phone: 631-290-7400
  • Fax:
Mailing address:
  • Phone: 631-290-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIETTE DOHERTY
Title or Position: OWNER
Credential: OT
Phone: 631-290-7400