# PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194216135
- **Authorized official:** KATHLEEN BRUSH (CREDENTIALING MANAGER)
- **Authorized official phone:** (631) 359-5805

## Contact information

- **Practice address:** 599 GRAMATAN AVE STE 205, FLEETWOOD, NY 10552
- **Practice address phone:** (914) 371-1990
- **Practice address fax:** (914) 371-7588
- **Mailing address:** 576 BROADHOLLOW RD, MELVILLE, NY 11747-5002
- **Mailing address phone:** (631) 359-5859
- **Mailing address fax:** (631) 396-0865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/25/2018
- **Last updated:** 05/30/2018