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General NPI Number Information
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NPI Number | 1164872669
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Entity Type | Organization
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Legal Business Name | ILLARI PHYSCIAL THERAPY P.C.
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 2314 N OCEAN AVE
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City | FARMINGVILLE
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State | NY
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Zip | 11738-2915
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Country | US
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Telephone | 631-438-0400
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Fax | 631-438-0401
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Provider Business Mailing Address
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Address Line | 51 CLEREMONT AVE
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City | SAINT JAMES
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State | NY
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Zip | 11780-1708
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Country | US
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Telephone | 631-447-2315
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Fax | 631-447-2297
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Authorized Official
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Title or Position | DIRECTOR
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Name | MEGAN B ILLARI
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Credential | P.T.
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Telephone | 631-252-1512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 018220
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License Number State | NY
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