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General NPI Number Information
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NPI Number | 1245379759
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Entity Type | Organization
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Legal Business Name | LONG ISLAND PEDIATRIC PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 99 TULIP AVE SUITE 407
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City | FLORAL PARK
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State | NY
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Zip | 11001-1974
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Country | US
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Telephone | 516-358-9146
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Fax |
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Provider Business Mailing Address
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Address Line | 99 TULIP AVE SUITE 407
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City | FLORAL PARK
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State | NY
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Zip | 11001-1974
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Country | US
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Telephone | 516-358-9146
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILIP J KOCH
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Credential | PT
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Telephone | 516-358-9146
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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 | 006167
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License Number State | NY
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