Provider Demographics
NPI:1164708590
Name:ERIK PETERSON PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ERIK PETERSON PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-324-3200
Mailing Address - Street 1:PO BOX 2835
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-2835
Mailing Address - Country:US
Mailing Address - Phone:631-324-3200
Mailing Address - Fax:631-324-3676
Practice Address - Street 1:100 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930-2835
Practice Address - Country:US
Practice Address - Phone:631-324-3200
Practice Address - Fax:631-324-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0235331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty