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General NPI Number Information
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NPI Number | 1972655041
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Entity Type | Organization
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Legal Business Name | NORTH FORK PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31 MAIN RD SUITE 4
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City | RIVERHEAD
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State | NY
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Zip | 11901-1953
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Country | US
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Telephone | 631-208-2900
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Fax | 631-208-2929
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Provider Business Mailing Address
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Address Line | PO BOX 2442
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City | AQUEBOGUE
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State | NY
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Zip | 11931-2442
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Country | US
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Telephone | 631-208-2900
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Fax | 631-208-2929
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MARC P WAHL
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Credential | PT
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Telephone | 631-208-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 019081-1
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License Number State | NY
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