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General NPI Number Information
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NPI Number | 1346782158
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Entity Type | Organization
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Legal Business Name | STALLION PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 590 NICOLLS RD
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City | DEER PARK
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State | NY
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Zip | 11729-3217
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Country | US
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Telephone | 631-392-1283
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 ERMA DR
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City | EAST MEADOW
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State | NY
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Zip | 11554-1119
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Country | US
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Telephone | 347-653-1389
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN L PO-ALMEDILLA
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Credential | DPT
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Telephone | 347-653-1389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 029106
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License Number State | NY
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