Provider Demographics
NPI:1083771836
Name:VILLAGE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:VILLAGE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:631-651-8644
Mailing Address - Street 1:433 FORT SALONGA RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3048
Mailing Address - Country:US
Mailing Address - Phone:631-651-8644
Mailing Address - Fax:631-651-8645
Practice Address - Street 1:433 FORT SALONGA RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3048
Practice Address - Country:US
Practice Address - Phone:631-651-8644
Practice Address - Fax:631-651-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAWTT1Medicare PIN