Organization
BACK IN ACTION PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL V PROCACCINI P.T . M.S. (PHYSICAL THERAPIST)
(631) 941-3295
Entity
Organization
Contact information
Practice address
55 HOPEWELL DR, STONY BROOK, NY 11790-2340
(631) 258-9538
Mailing address
55 HOPEWELL DR, STONY BROOK, NY 11790-2340
(631) 258-9538
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
020541-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q12B71
MEDICARE PROVIDER
NY
Enumeration date
09/23/2008
Last updated
09/23/2008
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