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General NPI Number Information
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NPI Number | 1689966178
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Entity Type | Organization
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Legal Business Name | FIRST STEP PHYSICAL THERAPY OF LONG ISLAND
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 900 WALT WHITMAN RD SUITE 310
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City | MELVILLE
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State | NY
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Zip | 11747-2293
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Country | US
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Telephone | 631-923-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 900 WALT WHITMAN RD SUITE 310
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City | MELVILLE
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State | NY
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Zip | 11747-2293
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN LYSAGHT
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Credential | PT, OCS
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Telephone | 631-923-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 021743
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License Number State | NY
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