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General NPI Number Information
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NPI Number | 1104476449
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Entity Type | Organization
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Legal Business Name | GOAL PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 6 GRAMATAN AVE STE 203
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3209
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Country | US
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Telephone | 516-404-8052
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Fax |
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Provider Business Mailing Address
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Address Line | 91 ROOSEVELT DR
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City | EAST NORWICH
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State | NY
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Zip | 11732-1126
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Country | US
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Telephone | 516-404-8052
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | CYNTHIA I LETT
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Credential | PT
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Telephone | 516-404-8052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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