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General NPI Number Information
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NPI Number | 1467789339
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Entity Type | Organization
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Legal Business Name | JOAN MACKEY PT PC
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 590 NICOLLS RD
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City | DEER PARK
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State | NY
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Zip | 11729-3217
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Country | US
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Telephone | 631-254-4945
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Fax |
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Provider Business Mailing Address
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Address Line | 590 NICOLLS RD
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City | DEER PARK
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State | NY
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Zip | 11729-3217
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Country | US
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Telephone | 631-254-4945
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOAN MACKEY
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Credential | PT
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Telephone | 631-254-4945
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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 | 8331
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License Number State | NY
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