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General NPI Number Information
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NPI Number | 1750685376
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Entity Type | Organization
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Legal Business Name | ONEONONEPT PLLC
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 1149 ROUTE 58 STE A2
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City | RIVERHEAD
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State | NY
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Zip | 11901-2059
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Country | US
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Telephone | 631-284-9258
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 ROUTE 58 STE A2
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City | RIVERHEAD
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State | NY
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Zip | 11901-2059
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Country | US
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Telephone | 631-428-6235
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | MANTAS KORSAKAS
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Credential |
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Telephone | 631-284-9258
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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 |
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License Number State |
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