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General NPI Number Information
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NPI Number | 1538110838
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Entity Type | Organization
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Legal Business Name | T.L.C.PHYSICAL THERAPY,P.C.
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 197 SMITHTOWN BLVD
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City | NESCONSET
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State | NY
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Zip | 11767-1849
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Country | US
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Telephone | 631-863-1290
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Fax | 631-863-3090
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Provider Business Mailing Address
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Address Line | 197 SMITHTOWN BLVD
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City | NESCONSET
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State | NY
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Zip | 11767-1849
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Country | US
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Telephone | 631-863-1290
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Fax | 631-863-3090
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Authorized Official
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Title or Position | OWNER
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Name | TINA ELDERBAUM
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Credential | PT
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Telephone | 631-863-1290
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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 | NY
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