| NPI | 1053932590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN BRUSH Manager 631-359-5805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-05-06 |