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Organization
PRO PERFORMANCE PHYSICAL THERAPY AND WELLNESS, PLLC
Active
Organization
PRO PERFORMANCE PHYSICAL THERAPY AND WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN A VENEGAS PT (MEMBER)
(516) 277-1153
Entity
Organization
Contact information
Practice address
70 GLEN ST, SUITE 380, GLEN COVE, NY 11542-2855
(516) 277-1153
(516) 277-1154
Mailing address
70 GLEN ST, SUITE 380, GLEN COVE, NY 11542-2855
(516) 277-1153
(516) 277-1154
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
015585-1
NY
2251S0007X
Sports Physical Therapist
015585-1
NY
2251X0800X
Orthopedic Physical Therapist
Primary
015585-1
NY
Other
Enumeration date
04/21/2008
Last updated
10/01/2008
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