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General NPI Number Information
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NPI Number | 1659476968
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Entity Type | Organization
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Legal Business Name | NY PHYSICAL THERAPY & WELLNESS, MELVILLE, PLLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 535 BROADHOLLOW RD SUITE A10
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City | MELVILLE
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State | NY
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Zip | 11747-3713
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Country | US
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Telephone | 631-694-0005
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Fax | 631-694-0007
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Provider Business Mailing Address
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Address Line | 1800 WALT WHITMAN RD STE 120
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City | MELVILLE
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State | NY
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Zip | 11747-3237
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Country | US
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Telephone | 631-694-0005
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Fax | 631-694-0007
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Authorized Official
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Title or Position | PT / OWNER
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Name | MR. RONALD J BREDOW
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Credential | PT
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Telephone | 631-694-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 021022-1
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License Number State | NY
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