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General NPI Number Information
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NPI Number | 1447681796
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Entity Type | Organization
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Legal Business Name | DEER PARK PT & PTA PHYSICAL THERAPY & REHABILITATION, PLLC
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 505 GRAND BLVD SUITE 4
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City | DEER PARK
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State | NY
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Zip | 11729-5300
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Country | US
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Telephone | 631-940-9800
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Fax | 631-940-9801
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Provider Business Mailing Address
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Address Line | 505 GRAND BLVD SUITE 4
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City | DEER PARK
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State | NY
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Zip | 11729-5300
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Country | US
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Telephone | 631-940-9800
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Fax | 631-940-9801
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Authorized Official
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Title or Position | CEO
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Name | DOUGLAS ANTHONY ALBERICI
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Credential | P.T.
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Telephone | 631-741-9857
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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 |
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License Number State |
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