Healthcare Provider Details

I. General information

NPI: 1598693442
Provider Name (Legal Business Name): RUSSELL HU PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CAPITOL AVE
WILLISTON PARK NY
11596-1620
US

IV. Provider business mailing address

107 CAPITOL AVE
WILLISTON PARK NY
11596-1620
US

V. Phone/Fax

Practice location:
  • Phone: 516-589-3186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL HU
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 516-589-3186