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General NPI Number Information
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NPI Number | 1235285271
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Entity Type | Organization
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Legal Business Name | MARATHON PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 330 GREAT NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-4227
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Country | US
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Telephone | 516-487-9810
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Fax | 516-773-7315
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Provider Business Mailing Address
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Address Line | 330 GREAT NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-4227
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Country | US
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Telephone | 516-487-9810
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Fax | 516-773-7315
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | PERRY BONOMO
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Credential |
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Telephone | 516-487-9810
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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 |
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License Number State |
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