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General NPI Number Information
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NPI Number | 1659194710
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Entity Type | Organization
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Legal Business Name | HOLISTIC FUNCTION AND REHABILITATION SERVICES LLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 209 POINTE CIR N
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City | CORAM
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State | NY
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Zip | 11727-1543
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Country | US
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Telephone | 631-921-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 209 POINTE CIR N
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City | CORAM
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State | NY
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Zip | 11727-1543
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Country | US
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Telephone | 631-921-1215
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / EMPLOYEE
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Name | JILLIAN M SECRETO
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Credential | OT
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Telephone | 631-921-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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