| NPI | 1255703807 |
|---|---|
| Doing Business As | PATCHOGUE-MEDFORD PTDC |
| Entity Type | Organization |
| Authorized Contact | JACK TESORIERO Managing Member 631-617-5040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025310) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 004766) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2016-01-06 |