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General NPI Number Information
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NPI Number | 1174922074
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Entity Type | Organization
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Legal Business Name | GAIT ANALYTICS PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 7 LAURITA GATE
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2113
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Country | US
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Telephone | 631-459-7985
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Fax |
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Provider Business Mailing Address
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Address Line | 7 LAURITA GATE
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2113
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Country | US
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Telephone | 631-459-7985
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DAVID NIEVES
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Credential | PT
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Telephone | 631-459-7985
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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 | 015511-1
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License Number State | NY
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