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Organization
PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Active
Organization
PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN BRUSH (CREDENTIALING MANAGER)
(718) 819-6805
Entity
Organization
Contact information
Practice address
70 N COUNTRY RD, PORT JEFFERSON, NY 11777-2161
(631) 331-3608
(631) 331-2392
Mailing address
576 BROADHOLLOW RD, MELVILLE, NY 11747-5002
(631) 359-5859
(631) 396-0865
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
03/18/2016
Last updated
03/28/2018
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