Organization
BLC PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEILA HISOLE CEBALLOS PT,DPT (CO OWNER)
(631) 839-4059
Entity
Organization
Contact information
Practice address
320 POST AVE STE 100, WESTBURY, NY 11590-2258
(631) 839-4059
Mailing address
15 MONMOUTH ST, DEER PARK, NY 11729-2514
(631) 839-4059
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
019468
NY
Other
Enumeration date
03/14/2016
Last updated
03/14/2016
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