Provider Demographics
NPI:1356849491
Name:ENERGIZE HOME PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ENERGIZE HOME PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:631-951-7776
Mailing Address - Street 1:33 GREAT OAK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1414
Mailing Address - Country:US
Mailing Address - Phone:631-951-7776
Mailing Address - Fax:631-382-8324
Practice Address - Street 1:33 GREAT OAK RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1414
Practice Address - Country:US
Practice Address - Phone:631-951-7776
Practice Address - Fax:631-382-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0329931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAS87Medicaid