Healthcare Provider Details

I. General information

NPI: 1659631745
Provider Name (Legal Business Name): REACH FOR THE STARS PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 NEIL DR
SMITHTOWN NY
11787-1241
US

IV. Provider business mailing address

48 NEIL DR
SMITHTOWN NY
11787-1241
US

V. Phone/Fax

Practice location:
  • Phone: 631-786-7911
  • Fax:
Mailing address:
  • Phone: 631-786-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number018817-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. THOMAS GEORGE LUCCA II
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.
Phone: 631-786-7911