Provider Demographics
NPI:1457321911
Name:DESOUSA, STEVEN C (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:DESOUSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 LARKFIELD RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4205
Mailing Address - Country:US
Mailing Address - Phone:631-266-4501
Mailing Address - Fax:631-266-4502
Practice Address - Street 1:554 LARKFIELD RD
Practice Address - Street 2:SUITE 207
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4205
Practice Address - Country:US
Practice Address - Phone:631-266-4501
Practice Address - Fax:631-266-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0138961225100000X, 2251H1200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00899OtherMDNY PROVIDER ID
6699926OtherGHI PROVIDER ID
NY01914598Medicaid
Q38811OtherBC BS PROVIDER ID
54388OtherVYTRA ID
A2517039OtherOXFORD PROVIDER ID
NY01914598Medicaid