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General NPI Number Information
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NPI Number | 1790984425
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Entity Type | Organization
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Legal Business Name | MED PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 775 PARK AVE SUITE 200-12
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City | HUNTINGTON
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State | NY
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Zip | 11743
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Country | US
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Telephone | 631-385-0066
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Fax | 631-385-0770
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Provider Business Mailing Address
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Address Line | 1035 WESTMINSTER AVE
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City | DIX HILLS
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State | NY
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Zip | 11746
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Country | US
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Telephone | 631-385-0066
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Fax | 631-385-0770
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Authorized Official
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Title or Position | PHYSICAL THERAPY DIRECTOR
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Name | DR. FARHAD HAERI
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Credential | PT DPT
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Telephone | 631-385-0066
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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 | 0155911
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License Number State | NY
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