Provider Demographics
NPI:1063457661
Name:SUNSHINE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:SUNSHINE PHYSICAL THERAPY, PC
Other - Org Name:SUNSHINE ORTHOPEDIC & SPORTS PHYSICAL THERAPY, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULE-GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-499-1038
Mailing Address - Street 1:297 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3401
Mailing Address - Country:US
Mailing Address - Phone:631-499-1038
Mailing Address - Fax:631-499-2293
Practice Address - Street 1:297 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3401
Practice Address - Country:US
Practice Address - Phone:631-499-1038
Practice Address - Fax:631-499-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5744-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty