Provider Demographics
NPI:1275813990
Name:DIX HILLS PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:DIX HILLS PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSSANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-549-1550
Mailing Address - Street 1:1206 E JERICHO TPKE UNIT A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5453
Mailing Address - Country:US
Mailing Address - Phone:631-549-1550
Mailing Address - Fax:631-549-1562
Practice Address - Street 1:1206 E JERICHO TPKE UNIT A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5453
Practice Address - Country:US
Practice Address - Phone:631-549-1550
Practice Address - Fax:631-549-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty