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General NPI Number Information
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NPI Number | 1629533773
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Entity Type | Organization
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Legal Business Name | BALANCED GAIT PHYSICAL THERAPY P.C
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 160 COMMACK RD STE LL3
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City | COMMACK
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State | NY
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Zip | 11725-3412
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Country | US
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Telephone | 631-338-4073
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Fax |
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Provider Business Mailing Address
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Address Line | 2 DALTON CT
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City | SOUTH HUNTINGTON
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State | NY
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Zip | 11746-4530
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Country | US
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Telephone | 631-338-4073
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Fax | 631-873-4030
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. SUSAN THOMAS
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Credential |
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Telephone | 631-338-4073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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