Provider Demographics
NPI:1053689323
Name:SAGNELLA PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SAGNELLA PHYSICAL THERAPY PLLC
Other - Org Name:SAGNELLA PHYSICAL THERAPY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SAGNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MAPT
Authorized Official - Phone:631-566-2793
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-0492
Mailing Address - Country:US
Mailing Address - Phone:631-566-2793
Mailing Address - Fax:631-320-0932
Practice Address - Street 1:11 1ST AVE
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1001
Practice Address - Country:US
Practice Address - Phone:631-566-2793
Practice Address - Fax:631-320-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty