Healthcare Provider Details

I. General information

NPI: 1851462535
Provider Name (Legal Business Name): BABYLON PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 E SUNRISE HIGHWAY
WEST BABYLON NY
11704
US

IV. Provider business mailing address

576 E SUNRISE HIGHWAY
WEST BABYLON NY
11704
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-0318
  • Fax: 631-376-0319
Mailing address:
  • Phone: 631-376-0318
  • Fax: 631-376-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000402
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019531
License Number StateNY

VIII. Authorized Official

Name: MR. JEFFREY D CHICHESTER
Title or Position: PHYSICAL THERAPIST OWNER
Credential: PT PHYSICAL THERAPY
Phone: 631-376-0318