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General NPI Number Information
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NPI Number | 1780380840
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Entity Type | Organization
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Legal Business Name | INTENT REHAB PERFORMANCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 351 LARKFIELD RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-2940
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Country | US
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Telephone | 631-209-7431
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Fax |
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Provider Business Mailing Address
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Address Line | 34 GEORGIA ST
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-2230
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Country | US
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Telephone | 631-942-1472
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. ALEX EGGLINGER
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Credential | DPT
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Telephone | 631-209-7431
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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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