=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902088008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN ARM PHYSICAL THERAPY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 09/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74825A MAIN RD SUITE 2
-----------------------------------------------------
City | GREENPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11944-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-477-4959
-----------------------------------------------------
Fax | 631-477-4184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 WILLIAMS WAY S
-----------------------------------------------------
City | CALVERTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11933-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-591-2324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. BRIAN JAMES ARM
-----------------------------------------------------
Credential | M.S.P.T.
-----------------------------------------------------
Telephone | 631-477-4959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 020686-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------