Provider Demographics
NPI:1124394457
Name:UNIVERSUS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:UNIVERSUS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHATTAS RYGLEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:221 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2924
Mailing Address - Country:US
Mailing Address - Phone:631-533-2888
Mailing Address - Fax:631-638-5584
Practice Address - Street 1:221 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2924
Practice Address - Country:US
Practice Address - Phone:631-533-2888
Practice Address - Fax:631-683-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028157OtherLICENSE