Provider Demographics
NPI:1437364916
Name:PREMIER PHYSICAL THERAPY OF ROCKLAND LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY OF ROCKLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-368-4111
Mailing Address - Street 1:100 ROUTE 59
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-368-4111
Mailing Address - Fax:845-368-4114
Practice Address - Street 1:100 ROUTE 59
Practice Address - Street 2:SUITE 103
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-368-4111
Practice Address - Fax:845-368-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0219531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAWZQ1Medicare PIN