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General NPI Number Information
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NPI Number | 1376930974
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Entity Type | Organization
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Legal Business Name | GNLC PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 500 PORTION RD SUITE5
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-4587
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Country | US
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Telephone | 631-588-2100
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Fax | 631-588-2299
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Provider Business Mailing Address
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Address Line | 500 PORTION RD SUITE5
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-4587
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Country | US
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Telephone | 631-588-2100
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Fax | 631-588-2299
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JILL SZUFLADA
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Credential |
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Telephone | 631-588-2100
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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 | 033193
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22606
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License Number State | NY
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