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General NPI Number Information
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NPI Number | 1124394457
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Entity Type | Organization
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Legal Business Name | UNIVERSUS PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 221 E MAIN ST
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City | HUNTINGTON
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State | NY
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Zip | 11743-2924
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Country | US
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Telephone | 631-533-2888
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Fax | 631-683-5584
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Provider Business Mailing Address
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Address Line | 221 E MAIN ST
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City | HUNTINGTON
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State | NY
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Zip | 11743-2924
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Country | US
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Telephone | 631-533-2888
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Fax | 631-638-5584
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Authorized Official
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Title or Position | OWNER
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Name | SHADEN GHATTAS RYGLEWICZ
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Credential | P.T.
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Telephone | 631-271-9151
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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 | 028157
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License Number State | NY
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