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General NPI Number Information
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NPI Number | 1093892788
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY LONG ISLAND, P.C.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 65 FROEHLICH FARM BLVD STE 73
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City | WOODBURY
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State | NY
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Zip | 11797-2926
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Country | US
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Telephone | 516-682-0466
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Fax | 516-682-0465
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Provider Business Mailing Address
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Address Line | 65 FROEHLICH FARM BLVD STE 73
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City | WOODBURY
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State | NY
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Zip | 11797-2926
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Country | US
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Telephone | 516-682-0466
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Fax | 516-682-0465
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ROBERT NICI
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Credential | PT
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Telephone | 516-682-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 8355-1
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License Number State | NY
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