=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215816152
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY RABER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 HAWTHORNE AVE
-----------------------------------------------------
City | CENTRAL ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11722-2418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-579-6572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 HAWTHORNE AVE
-----------------------------------------------------
City | CENTRAL ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11722-2418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 013948-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------