Provider Demographics
NPI:1205040359
Name:LINEHAN PHYSICAL THERAPY OF LONG ISLAND, PC
Entity Type:Organization
Organization Name:LINEHAN PHYSICAL THERAPY OF LONG ISLAND, PC
Other - Org Name:PREMIER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:631-981-7422
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-0144
Mailing Address - Country:US
Mailing Address - Phone:631-981-7422
Mailing Address - Fax:631-981-2490
Practice Address - Street 1:650 HAWKINS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2366
Practice Address - Country:US
Practice Address - Phone:631-981-7422
Practice Address - Fax:631-981-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy