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General NPI Number Information
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NPI Number | 1447555362
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PHYSICAL THERAPY OF SUFFOLK, P.C.
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 156 4TH AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7900
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Country | US
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Telephone | 631-647-7194
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Fax |
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Provider Business Mailing Address
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Address Line | 156 4TH AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7900
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Country | US
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Telephone | 631-647-7194
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAYCIE SENASE
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Credential | P.T.
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Telephone | 631-647-7194
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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 | 010606
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License Number State | NY
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