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General NPI Number Information
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NPI Number | 1891184511
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Entity Type | Organization
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Legal Business Name | THERADYNAMICS REHAB MGMT., LLC
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 225 CROSSWAYS PARK DR
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City | WOODBURY
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State | NY
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Zip | 11797-2054
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Country | US
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Telephone | 516-422-7840
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Fax |
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Provider Business Mailing Address
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Address Line | 225 CROSSWAYS PARK DR
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City | WOODBURY
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State | NY
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Zip | 11797-2054
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Country | US
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Telephone | 516-422-7840
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MRS. JOCELYN DEGUZAN
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Credential | RPT
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Telephone | 347-610-0427
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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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