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General NPI Number Information
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NPI Number | 1164529871
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Entity Type | Organization
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Legal Business Name | MITCHELL T YASS PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 309 NORTHWEST DR
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City | FARMINGDALE
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State | NY
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Zip | 11735-4935
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Country | US
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Telephone | 516-420-2900
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Fax | 516-420-2908
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Provider Business Mailing Address
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Address Line | 309 NORTHWEST DR
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City | FARMINGDALE
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State | NY
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Zip | 11735-4935
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Country | US
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Telephone | 516-420-2900
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Fax | 516-420-2908
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Authorized Official
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Title or Position | PRESIDENT
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Name | MITCHELL T YASS
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Credential | PT
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Telephone | 516-420-2900
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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 | 0137051
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License Number State | NY
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