Provider Demographics
NPI:1336298801
Name:SUFFOLK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SUFFOLK PHYSICAL THERAPY PC
Other - Org Name:NASSAU SUFFOLK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:PARTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-364-2554
Mailing Address - Street 1:6800 JERICHO TPKE
Mailing Address - Street 2:SUITE 114W
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4436
Mailing Address - Country:US
Mailing Address - Phone:516-364-2554
Mailing Address - Fax:516-364-5328
Practice Address - Street 1:6800 JERICHO TPKE
Practice Address - Street 2:SUITE 114W
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4436
Practice Address - Country:US
Practice Address - Phone:516-364-2554
Practice Address - Fax:516-364-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-11-05
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
NYANC1486OtherOXFORD PIN NUMBER
NY0056198OtherAETNA PIN NUMBER
NYANC1486OtherOXFORD PIN NUMBER