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NPI Code Detail

MEDICARE: SOUTH SHORE WELLNESS PHYSICAL THERAPY PC

MEDICARE: SOUTH SHORE WELLNESS PHYSICAL THERAPY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1013505734
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH SHORE WELLNESS PHYSICAL THERAPY PC
Provider Business Mailing Address
First Line : 1041 ROUTE 112
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-6000
Country : US
Telephone Number : 631-828-4545
Fax Number : 631-828-4552
Provider Business Practice Location Address
First Line : 1041 ROUTE 112
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-6000
Country : US
Telephone Number : 631-828-4545
Fax Number : 631-828-4552
Authorized Official
Title or Position : OWNER
Name : GLENDA MAPA
Credential : PT
Telephone Number : 631-828-4545
Provider Enumeration Date : 01/07/2021
Last Update Date : 01/07/2021

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Directions to “SOUTH SHORE WELLNESS PHYSICAL THERAPY PC ” Practice Location

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