=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770644742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRS HOMEBASED PHYSICAL THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 672 S COUNTRY RD
-----------------------------------------------------
City | EAST PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-5549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-654-5282
-----------------------------------------------------
Fax | 631-654-5253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 672 S COUNTRY RD
-----------------------------------------------------
City | EAST PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-5549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-654-5282
-----------------------------------------------------
Fax | 631-654-5253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST DIRECTOR
-----------------------------------------------------
Name | MR. CHRISTOPHER ROBERT SCHWENKER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 631-654-5282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 017277
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------