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General NPI Number Information
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NPI Number | 1962623918
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Entity Type | Organization
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Legal Business Name | SUFFOLK COUNTY PHYSICAL THERAPY P C
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 279 LARKFIELD RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-2415
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Country | US
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Telephone | 631-262-1370
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Fax | 631-262-0415
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Provider Business Mailing Address
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Address Line | 279 LARKFIELD RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-2415
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Country | US
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Telephone | 631-262-1370
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Fax | 631-262-0415
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS GRUHN
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Credential | PT
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Telephone | 631-262-1370
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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 | 012195
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License Number State | NY
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