MEDICARE: SMITHTOWN PHYSICAL THERAPY AND CHIROPRACTIC , PLLC

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	111N00000X	Chiropractor
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1982328597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITHTOWN PHYSICAL THERAPY AND CHIROPRACTIC , PLLC

Provider Business Mailing Address
First Line	:	32 LAWRENCE AVE STE 107
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3605
Country	:	US
Telephone Number	:	631-265-1727
Fax Number	:	631-265-9014

Provider Business Practice Location Address
First Line	:	32 LAWRENCE AVE STE 107
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3605
Country	:	US
Telephone Number	:	631-265-1727
Fax Number	:	631-265-9014

Authorized Official
Title or Position	:	PROVIDER/AO/OWNER
Name	:	DR. DAVID A WALLMAN
Credential	:	DC
Telephone Number	:	631-265-1727

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	04/24/2025

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