Provider Demographics
NPI:1194826651
Name:WADING RIVER PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:WADING RIVER PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VANCURA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-929-8200
Mailing Address - Street 1:5958 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2001
Mailing Address - Country:US
Mailing Address - Phone:631-929-8200
Mailing Address - Fax:631-929-8228
Practice Address - Street 1:5958 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2001
Practice Address - Country:US
Practice Address - Phone:631-929-8200
Practice Address - Fax:631-929-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN78062OtherHEALTHNET
NY2N5211OtherCHILD HEALTH PLUS
NYN78062OtherHEALTHNET