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General NPI Number Information
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NPI Number | 1427235852
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Entity Type | Organization
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Legal Business Name | INTERSTATE PHYSICAL THERAPY & MASSAGE PLLC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 375 MAIN ST
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City | ISLIP
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State | NY
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Zip | 11751-3521
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Country | US
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Telephone | 631-224-4904
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Fax |
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Provider Business Mailing Address
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Address Line | 375 MAIN ST
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City | ISLIP
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State | NY
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Zip | 11751-3521
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Country | US
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Telephone | 631-224-4904
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW STEVEN ZAGORSKI
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Credential | MSPT
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Telephone | 631-224-4904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 021889-1
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License Number State | NY
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