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General NPI Number Information
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NPI Number | 1962594143
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Entity Type | Organization
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Legal Business Name | PKL PHYSICAL THERAPY & WELLNESS, PC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 11 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2701
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Country | US
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Telephone | 631-691-6900
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Fax | 631-691-6910
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Provider Business Mailing Address
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Address Line | 11 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2701
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Country | US
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Telephone | 631-691-6900
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Fax | 631-691-6910
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Authorized Official
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Title or Position | PRESIDENT
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Name | PARSA KARIMI
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Credential | DPT
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Telephone | 631-691-6900
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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 | 025489
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License Number State | NY
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