Provider Demographics
NPI:1356325799
Name:PHYSIOLOGIC PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PHYSIOLOGIC PHYSICAL THERAPY PC
Other - Org Name:DONNA J CROCE PT PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:516-466-4118
Mailing Address - Street 1:98 CUTTERMILL RD
Mailing Address - Street 2:#100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-466-4118
Mailing Address - Fax:516-466-2856
Practice Address - Street 1:98 CUTTERMILL RD
Practice Address - Street 2:#100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-466-4118
Practice Address - Fax:516-466-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0084451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q66251OtherBCBS
47674OtherVYTRA
NYANC1007OtherOXFORD
A200697OtherMDNY
NY660637OtherGHI
Q66251OtherBCBS