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Organization
PROVIDENT PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Active
Organization
PROVIDENT PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN C DESOUSA PT, DPT, MA, OCS (OWNER/ PT)
(631) 266-4501
Entity
Organization
Contact information
Practice address
554 LARKFIELD RD STE 207, EAST NORTHPORT, NY 11731-4205
(631) 266-4501
(631) 266-4502
Mailing address
554 LARKFIELD RD STE 207, EAST NORTHPORT, NY 11731-4205
(631) 266-4501
(631) 266-4502
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NY
225X00000X
Occupational Therapist
—
NY
Other
Enumeration date
07/07/2017
Last updated
07/07/2017
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