Provider Demographics
NPI:1174677892
Name:SOUND BODY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOUND BODY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ECKARDT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-789-1900
Mailing Address - Street 1:317 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2709
Mailing Address - Country:US
Mailing Address - Phone:631-789-1900
Mailing Address - Fax:631-789-1985
Practice Address - Street 1:317 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2709
Practice Address - Country:US
Practice Address - Phone:631-789-1900
Practice Address - Fax:631-789-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081873-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14P71Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE