Provider Demographics
NPI:1043314172
Name:515 PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:515 PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIOGUARDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:631-473-5036
Mailing Address - Street 1:515 ROUTE 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:631-265-2225
Mailing Address - Fax:631-265-3610
Practice Address - Street 1:515 PHYSICAL THERAPY LLC
Practice Address - Street 2:SUITE 101
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-265-2225
Practice Address - Fax:631-265-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7WWS1Medicare ID - Type Unspecified