Organization
OLYMPUS PT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QUENNIE LADAO-SOTO PT (OWNER)
(914) 444-6235
Entity
Organization
Contact information
Practice address
694 FORT SALONGA RD, NORTHPORT, NY 11768-3147
(631) 754-3775
(631) 754-3816
Mailing address
2403 64TH ST APT 1F, BROOKLYN, NY 11204-3449
(914) 444-6235
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
032114
NY
Other
Enumeration date
05/24/2018
Last updated
10/13/2020
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