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General NPI Number Information
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NPI Number | 1164697801
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Entity Type | Organization
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Legal Business Name | NASSAU SPORTS PHYSICAL THERAPY OF HUNTINGTON PC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 200 W CARVER ST SUITE 4
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City | HUNTINGTON
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State | NY
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Zip | 11743-3303
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Country | US
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Telephone | 631-385-1155
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Fax | 631-385-0813
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Provider Business Mailing Address
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Address Line | 200 W CARVER ST SUITE 4
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City | HUNTINGTON
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State | NY
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Zip | 11743-3303
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Country | US
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Telephone | 631-385-1155
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Fax | 631-385-0813
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL H GALLAGHER
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Credential | PT
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Telephone | 631-385-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 009165-1
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License Number State | NY
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