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General NPI Number Information
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NPI Number | 1205019403
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Entity Type | Organization
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Legal Business Name | SHERRIE GLASSER PHYSICAL THERAPY/JOHN DOUGLAS PTA
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 5 BROWNS RD
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City | NESCONSET
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State | NY
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Zip | 11767
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Country | US
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Telephone | 631-849-6000
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Fax | 631-849-6002
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Provider Business Mailing Address
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Address Line | 18 HAMILTON PL
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City | LAKE GROVE
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State | NY
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Zip | 11755-1915
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Country | US
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Telephone | 516-454-6387
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Fax | 516-454-6303
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Authorized Official
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Title or Position | PHYSICAL THERAPY DIRECTOR
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Name | SHERRIE GLASSER
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Credential | MS, PT
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Telephone | 516-454-6387
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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 | 005253-1
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License Number State | NY
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