| NPI | 1487113171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN BRUSH Credentialing Manager 631-359-5805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-03-22 |