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General NPI Number Information
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NPI Number | 1841406980
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 200 MIDDLE COUNTRY RD
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-2520
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Country | US
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Telephone | 631-345-2005
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Fax | 631-345-5007
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Provider Business Mailing Address
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Address Line | 41 ECHO AVE
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City | MILLER PLACE
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State | NY
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Zip | 11764-2108
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Country | US
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Telephone | 631-331-2348
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Fax | 631-928-7068
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD A MCCREA
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Credential | PT
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Telephone | 631-345-2005
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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 | 011801-1
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License Number State | NY
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