Organization
PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLLEN BRUSH (CREDENTIALING MANAGER)
(631) 359-5859
Entity
Organization
Contact information
Practice address
390 STATE ROUTE 10 STE 202, RANDOLPH, NJ 07869-2141
(973) 895-9925
(973) 895-9927
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
—
—
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
10/10/2016
Last updated
04/23/2019
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