| NPI | 1184170979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN BRUSH Credentialing Coordinator Manager 631-359-5859 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2018-03-27 |