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General NPI Number Information
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NPI Number | 1194216135
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 599 GRAMATAN AVE STE 205
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City | FLEETWOOD
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State | NY
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Zip | 10552
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Country | US
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Telephone | 914-371-1990
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Fax | 914-371-7588
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Provider Business Mailing Address
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Address Line | 576 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-5002
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Country | US
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Telephone | 631-359-5859
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Fax | 631-396-0865
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | KATHLEEN BRUSH
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Credential |
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Telephone | 631-359-5805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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