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Organization
MASSAPEQUA PT & PTA PLLC
Active
Organization
MASSAPEQUA PT & PTA PLLC
Active
Other names
PEQUA PHYSICAL & AQUATIC THERAPY, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN DOUGLAS PTA (CEO)
(516) 454-6387
Entity
Organization
Contact information
Practice address
913 N BROADWAY, N MASSAPEQUA, NY 11758-2364
(516) 454-6387
(516) 454-6303
Mailing address
18 HAMILTON PL, LAKE GROVE, NY 11755-1915
(516) 454-6387
(516) 454-6303
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
024174-1
NY
2251G0304X
Geriatric Physical Therapist
020281-1
NY
2251N0400X
Neurology Physical Therapist
020281-1
NY
2251S0007X
Sports Physical Therapist
024174-1
NY
2251X0800X
Orthopedic Physical Therapist
024174-1
NY
Other
Enumeration date
03/23/2011
Last updated
06/12/2013
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