Provider Demographics
NPI:1467018291
Name:ACHIEVE WELLNESS PT OT PLLC
Entity Type:Organization
Organization Name:ACHIEVE WELLNESS PT OT PLLC
Other - Org Name:ACHIEVE WELLNESS PT OT PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:631-290-7400
Mailing Address - Street 1:239 BOYLE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1955
Mailing Address - Country:US
Mailing Address - Phone:631-290-7400
Mailing Address - Fax:
Practice Address - Street 1:239 BOYLE RD STE 3
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1955
Practice Address - Country:US
Practice Address - Phone:631-290-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty