=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245142512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 HEMPSTEAD TPKE STE B
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-755-7808
-----------------------------------------------------
Fax | 516-755-7809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 576 BROADHOLLOW RD
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | KERRI WILKINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-359-5859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------