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Organization
LATITUDE PHYSICAL THERAPY
Active
Organization
LATITUDE PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE JAY WILSON (CEO)
(631) 919-5189
Entity
Organization
Contact information
Practice address
34 BAY ST STE 205-206, SAG HARBOR, NY 11963-3104
(631) 241-3698
Mailing address
PO BOX 552, SAG HARBOR, NY 11963-0012
(631) 903-7996
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
12/13/2023
Last updated
02/09/2024
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