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General NPI Number Information
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NPI Number | 1144999053
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Entity Type | Organization
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Legal Business Name | GARY A. DESPRES PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 53345 MAIN ROAD BUILDING 8 UNIT 1
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City | SOUTHOLD
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State | NY
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Zip | 11971-4643
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Country | US
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Telephone | 631-806-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 875 S HARBOR RD
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City | SOUTHOLD
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State | NY
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Zip | 11971-4516
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Country | US
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Telephone | 631-806-2179
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY DESPRES
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Credential | DPT
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Telephone | 631-806-2179
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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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