| NPI | 1225697816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMELY ESTRADA Credentialing Coordinator 631-359-5859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2019-06-07 |