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General NPI Number Information
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NPI Number | 1811022759
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PHYSICAL THERAPY OF NY, P.C.
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 28 N COUNTRY RD SUITE 104
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City | MOUNT SINAI
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State | NY
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Zip | 11766-1518
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Country | US
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Telephone | 631-331-6047
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Fax |
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Provider Business Mailing Address
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Address Line | 81 TALLMADGE TRL
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City | MILLER PLACE
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State | NY
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Zip | 11764-2327
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Country | US
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Telephone | 631-473-6418
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD LEICHTER
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Credential | MA,PT
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Telephone | 631-331-6047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 015547
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License Number State | NY
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