Provider Demographics
NPI:1467670331
Name:SHERRIE GLASSER PHYSICAL THERAPY JOHN DOUGLAS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SHERRIE GLASSER PHYSICAL THERAPY JOHN DOUGLAS PHYSICAL THERAPY
Other - Org Name:METRO COMPREHENSIVE PHYSICAL & AQUATIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:516-454-6387
Mailing Address - Street 1:1061 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1802
Mailing Address - Country:US
Mailing Address - Phone:516-454-6387
Mailing Address - Fax:516-454-6303
Practice Address - Street 1:745 RTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778
Practice Address - Country:US
Practice Address - Phone:516-454-6387
Practice Address - Fax:516-454-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005253-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQOWDP1Medicare ID - Type Unspecified