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General NPI Number Information
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NPI Number | 1831260504
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Entity Type | Organization
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Legal Business Name | THREE VILLAGE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 11/10/2013
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Provider Practice Location Address
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Address Line | 97 MAIN ST SUITE F
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City | STONY BROOK
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State | NY
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Zip | 11790-1937
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Country | US
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Telephone | 631-355-2120
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Fax | 843-686-4000
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Provider Business Mailing Address
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Address Line | 6 OUTPOST LN
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City | HILTON HEAD ISLAND
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State | SC
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Zip | 29928-3802
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Country | US
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Telephone | 631-355-2120
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Fax | 843-686-4000
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT E DAYTON
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Credential | PT,CFMT
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Telephone | 631-355-2120
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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 | 014253-1
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License Number State | NY
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