Healthcare Provider Details

I. General information

NPI: 1356662357
Provider Name (Legal Business Name): COREFIT PHYSICAL THERAPY, OCCUPATIONAL THERAPY WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CAROLINE AVE
SMITHTOWN NY
11787-5742
US

IV. Provider business mailing address

16 CAROLINE AVE
SMITHTOWN NY
11787-5742
US

V. Phone/Fax

Practice location:
  • Phone: 516-909-8347
  • Fax: 631-656-9264
Mailing address:
  • Phone: 516-909-8347
  • Fax: 631-656-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025992-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number012200
License Number StateNY

VIII. Authorized Official

Name: MRS. KATHLEEN EATON ALAI-TAFTI
Title or Position: OWNER/PT
Credential: PT
Phone: 516-909-8347