MEDICARE: MR. STEVEN C DESOUSA PT

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
1	225100000X	Physical Therapist	0138961	NY
2	2251H1200X	Hand Physical Therapist	0138961	NY
3	2251S0007X	Sports Physical Therapist	0138961	NY
4	2251X0800X	Orthopedic Physical Therapist	0138961	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	AZ00899	OTHER	MDNY PROVIDER ID
2	6699926	OTHER	GHI PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	Q38811	OTHER	BC BS PROVIDER ID
5	54388	OTHER	VYTRA ID
6	A2517039	OTHER	OXFORD PROVIDER ID

General Provider Information

NPI Number	:	1457321911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN C DESOUSA PT

Provider Business Mailing Address
First Line	:	554 LARKFIELD RD
Second Line	:	SUITE 207
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-4205
Country	:	US
Telephone Number	:	631-266-4501
Fax Number	:	631-266-4502

Provider Business Practice Location Address
First Line	:	554 LARKFIELD RD
Second Line	:	SUITE 207
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-4205
Country	:	US
Telephone Number	:	631-266-4501
Fax Number	:	631-266-4502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/18/2008

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Directions to “ MR. STEVEN C DESOUSA PT” Practice Location

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