| NPI | 1831190453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRI WILKINSON Manager Of Credentialing 631-359-5589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2022-08-15 |