| NPI | 1255792552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEILA HISOLE CEBALLOS Co Owner 631-839-4059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 019468) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2016-03-14 |