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General NPI Number Information
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NPI Number | 1669003042
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Entity Type | Organization
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Legal Business Name | LIVE LONG IN HOME PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 841 COUNTY ROUTE 5
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City | EAST CHATHAM
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State | NY
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Zip | 12060-3022
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Country | US
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Telephone | 877-644-8090
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Fax | 646-839-2598
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Provider Business Mailing Address
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Address Line | 841 COUNTY ROUTE 5
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City | EAST CHATHAM
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State | NY
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Zip | 12060-3022
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Country | US
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Telephone | 877-644-8090
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Fax | 646-839-2598
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | CHARLES MORANO
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Credential | MSPT
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Telephone | 877-644-8090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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