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General NPI Number Information
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NPI Number | 1164012241
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Entity Type | Organization
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Legal Business Name | SAMODULSKI PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 68 W MAIN ST
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City | OYSTER BAY
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State | NY
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Zip | 11771-2284
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Country | US
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Telephone | 516-340-9501
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Fax | 516-340-9501
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Provider Business Mailing Address
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Address Line | 17 WEEKS AVE
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City | OYSTER BAY
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State | NY
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Zip | 11771-2308
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Country | US
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Telephone | 516-340-9501
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Fax | 516-340-9501
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Authorized Official
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Title or Position | OWNER
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Name | JULIAN THOMAS SAMODULSKI
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Credential | DPT
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Telephone | 347-489-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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