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General NPI Number Information
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NPI Number | 1265237747
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Entity Type | Organization
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Legal Business Name | LONG ISLAND MASSAGE THERAPY AND PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 191 PATCHOGUE YAPHANK RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4899
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Country | US
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Telephone | 631-775-0971
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Fax | 631-475-0975
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Provider Business Mailing Address
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Address Line | 191 PATCHOGUE YAPHANK RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4899
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Country | US
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Telephone | 631-775-0971
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Fax | 631-475-0975
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Authorized Official
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Title or Position | PRACTICE ADMIN
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Name | MRS. SARAH BAZOGE
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Credential |
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Telephone | 631-775-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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