Provider Demographics
NPI:1346782158
Name:STALLION PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:STALLION PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PO-ALMEDILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-653-1389
Mailing Address - Street 1:2030 ERMA DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1119
Mailing Address - Country:US
Mailing Address - Phone:347-653-1389
Mailing Address - Fax:
Practice Address - Street 1:590 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3217
Practice Address - Country:US
Practice Address - Phone:631-392-1283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029106261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy