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General NPI Number Information
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NPI Number | 1326174830
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Entity Type | Individual
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Provider Name | ROBERT ANDREW LICARI MS, PT
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6 OVERDALE CT
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City | HUNTINGTON
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State | NY
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Zip | 11743-6811
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Country | US
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Telephone | 631-423-1231
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Fax |
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Provider Business Mailing Address
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Address Line | 6 OVERDALE CT
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City | HUNTINGTON
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State | NY
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Zip | 11743-6811
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Country | US
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Telephone | 631-423-1231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 022104-1
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License Number State | NY
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