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Organization
ISLAND SPORTS PHYSICAL THERAPY OF CORAM PC
Active
Organization
ISLAND SPORTS PHYSICAL THERAPY OF CORAM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN RODEN PT OCS (DIRECTOR/OWNER)
(631) 732-3900
Entity
Organization
Contact information
Practice address
607 MIDDLE COUNTRY ROAD, CORAM, NY 11727
(631) 732-3900
(631) 732-3900
Mailing address
607 MIDDLE COUNTRY ROAD, CORAM, NY 11727
(631) 732-3900
(631) 732-3908
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14816
VYTRA
NY
01
—
2C0907
HEALTHNET
NY
01
—
A384995
OXFORD
NY
Enumeration date
03/02/2006
Last updated
03/31/2008
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