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General NPI Number Information
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NPI Number | 1750782256
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Entity Type | Organization
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Legal Business Name | DEER PARK PHYSICAL THERAPY & CHIROPRACTIC
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 2103 DEER PARK AVE
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City | DEER PARK
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State | NY
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Zip | 11729-1319
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Country | US
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Telephone | 631-242-4500
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Fax | 631-242-0885
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Provider Business Mailing Address
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Address Line | 2103 DEER PARK AVE
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City | DEER PARK
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State | NY
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Zip | 11729-1319
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Country | US
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Telephone | 631-242-4500
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Fax | 631-242-0885
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Authorized Official
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Title or Position | PHYSICAL THERAPY, OWNER
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Name | RONALD BREDOW
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Credential | MS, PT
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Telephone | 516-315-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 021022-1
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License Number State | NY
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