Provider Demographics
NPI:1275710469
Name:COMPREHENSIVE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GRUBER
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT, PT, MA, OCS
Authorized Official - Phone:631-543-9300
Mailing Address - Street 1:6268 JERICHO TPKE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2810
Mailing Address - Country:US
Mailing Address - Phone:631-543-9300
Mailing Address - Fax:631-462-1166
Practice Address - Street 1:6268 JERICHO TPKE
Practice Address - Street 2:SUITE 3
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2810
Practice Address - Country:US
Practice Address - Phone:631-543-9300
Practice Address - Fax:631-462-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012547-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty