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General NPI Number Information
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NPI Number | 1467018291
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Entity Type | Organization
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Legal Business Name | ACHIEVE WELLNESS PT OT PLLC
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 239 BOYLE RD STE 3
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City | SELDEN
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State | NY
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Zip | 11784-1955
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Country | US
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Telephone | 631-290-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 239 BOYLE RD STE 3
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City | SELDEN
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State | NY
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Zip | 11784-1955
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Country | US
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Telephone | 631-290-7400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIETTE DOHERTY
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Credential | OT
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Telephone | 631-290-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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