Provider Demographics
NPI:1376618587
Name:WILLEMEN PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:WILLEMEN PHYSICAL THERAPY, P.C.
Other - Org Name:PROGRESSIVE PHYSICAL THERAPY & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSATI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-673-4600
Mailing Address - Street 1:266 EAST PULASKI RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1601
Mailing Address - Country:US
Mailing Address - Phone:631-673-4600
Mailing Address - Fax:631-673-4621
Practice Address - Street 1:266 EAST PULASKI RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1601
Practice Address - Country:US
Practice Address - Phone:631-673-4600
Practice Address - Fax:631-673-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2015-11-30
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
NYANC1491OtherOXFORD
NY34101OtherCIGNA
NYQEW111Medicare PIN