Healthcare Provider Details

I. General information

NPI: 1235599002
Provider Name (Legal Business Name): LINDA SABELLICO P.T. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BIANCA CT
STATEN ISLAND NY
10312-6622
US

IV. Provider business mailing address

26 BIANCA CT
STATEN ISLAND NY
10312-6622
US

V. Phone/Fax

Practice location:
  • Phone: 646-580-7397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012696
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number012696
License Number StateNY

VIII. Authorized Official

Name: LINDA SABELLICO
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 646-580-7397