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General NPI Number Information
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NPI Number | 1699106039
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Entity Type | Organization
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Legal Business Name | ELIZABETH GAUDET PHYSICAL THERAPY, P.L.L.C.
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 34 WHITTIER STREET
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City | LYNBROOK
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State | NY
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Zip | 11563
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Country | US
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Telephone | 516-532-1435
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Fax |
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Provider Business Mailing Address
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Address Line | 34 WHITTIER STREET
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City | LYNBROOK
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State | NY
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Zip | 11563
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Country | US
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Telephone | 516-532-1435
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH GAUDET
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Credential | M.A.; P.T.
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Telephone | 516-532-1435
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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 | 010535
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License Number State | NY
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