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Organization
SOUTH BAY PHYSICAL THERAPY AND SPORTS REHABILITATION PC
Active
Organization
SOUTH BAY PHYSICAL THERAPY AND SPORTS REHABILITATION PC
Active
Other names
Great South Bay Physical Therapy & Sports Rehabilitation PC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COSMO PHILIP BACCARELLA PT (PRESIDENT)
(631) 581-0006
Entity
Organization
Contact information
Practice address
393 MOFFITT BLVD, ISLIP, NY 11751
(631) 581-0006
(631) 581-0990
Mailing address
393 MOFFITT BLVD, ISLIP, NY 11751-2708
(631) 581-0006
(631) 581-0990
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0240191
NY
Other
Enumeration date
02/02/2007
Last updated
01/23/2018
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