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NPI Code Detail

MEDICARE: MR. STEPHEN MICHAEL JOSEPH MA, PT, ATC, CSCS

MEDICARE: MR. STEPHEN MICHAEL JOSEPH MA, PT, ATC, CSCS
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
12251P0200XPediatric Physical Therapist016663NY
22251S0007XSports Physical Therapist016663NY
32251X0800XOrthopedic Physical Therapist016663NY
4225100000XPhysical Therapist016663NY

General Provider Information

NPI Number : 1063497717
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN MICHAEL JOSEPH MA, PT, ATC, CSCS
Provider Business Mailing Address
First Line : 20 PEACHTREE CT
Second Line : SUITE 105
City : HOLBROOK
State : NY
Zip : 11741-4616
Country : US
Telephone Number : 631-467-3700
Fax Number : 631-467-0928
Provider Business Practice Location Address
First Line : 20 PEACHTREE CT
Second Line : SUITE 105
City : HOLBROOK
State : NY
Zip : 11741-4616
Country : US
Telephone Number : 631-467-3700
Fax Number : 631-467-0928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 03/08/2021

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