Healthcare Provider Details

I. General information

NPI: 1275957409
Provider Name (Legal Business Name): THERAHEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 UNION ST
VALLEY STREAM NY
11580-5211
US

IV. Provider business mailing address

31 UNION ST
VALLEY STREAM NY
11580-5211
US

V. Phone/Fax

Practice location:
  • Phone: 516-477-6573
  • Fax:
Mailing address:
  • Phone: 516-477-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNE CAROLINE THEOGENE
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 516-477-6573