Healthcare Provider Details

I. General information

NPI: 1154352888
Provider Name (Legal Business Name): GENERATIONS PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MONTAUK HWY SUITE 103
WEST ISLIP NY
11795-4208
US

IV. Provider business mailing address

400 MONTAUK HWY SUITE 103
WEST ISLIP NY
11795-4208
US

V. Phone/Fax

Practice location:
  • Phone: 631-661-3700
  • Fax: 631-661-3749
Mailing address:
  • Phone: 631-661-3700
  • Fax: 631-661-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7484
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHY VIOLA
Title or Position: OFFICE MGR.
Credential:
Phone: 631-661-3700