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General NPI Number Information
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NPI Number | 1952577421
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Entity Type | Organization
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Legal Business Name | VILLAGE PHYSICAL THERAPY & WELLNESS, PC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 330 SUNRISE HWY SUITE 100
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4977
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Country | US
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Telephone | 516-766-7848
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Fax | 888-316-2480
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Provider Business Mailing Address
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Address Line | PO BOX 529
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11571-0529
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Country | US
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Telephone | 516-766-7848
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Fax | 888-316-2480
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Authorized Official
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Title or Position | CEO
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Name | KAREN A RAFFERTY
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Credential | P.T.
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Telephone | 516-766-7848
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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 | 024144
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License Number State | NY
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