=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679713028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDURANCE PHYSICAL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2009
-----------------------------------------------------
Last Update Date | 10/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 189 BROADWAY
-----------------------------------------------------
City | AMITYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-608-3444
-----------------------------------------------------
Fax | 631-608-3445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 189 BROADWAY
-----------------------------------------------------
City | AMITYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-608-3444
-----------------------------------------------------
Fax | 631-608-3445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | REBECCA R HELLER-CASTILLO
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 631-608-3444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 026435
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------