=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083816698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY SOLUTIONS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 GEOFFREY LN
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-791-1044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 GEOFFREY LN
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-791-1044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RUSSELL SHVARTSSHTEYN
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 516-791-1044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 019129-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------