Provider Demographics
NPI:1477558997
Name:BAXTER AND WALSH PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BAXTER AND WALSH PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FURNO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-826-0116
Mailing Address - Street 1:33 ABBOTT PL
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7507
Mailing Address - Country:US
Mailing Address - Phone:631-669-2689
Mailing Address - Fax:
Practice Address - Street 1:2237A WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3917
Practice Address - Country:US
Practice Address - Phone:516-826-0116
Practice Address - Fax:516-826-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017901-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17401OtherCIGNA ORTHONET
NY3C3953OtherHEALTHNET
NY=========OtherEVOLUTIONS HEALTHCARE SYS
NY=========OtherINTERSTATE CHOICE MGMT
NY=========OtherUPSTATE ADMINISTRATIVE SV
NY3C3953OtherHEALTHNET
NY=========OtherMCS
NY=========OtherMULTIPLAN
NY=========OtherCHAMPUS/TRICARE
NY=========OtherGEHA PPO
NY=========OtherINTEGRATED HEALTH PLAN
NY=========OtherPLAN VISTA/NPPN
NY=========OtherPOMCO
NY=========OtherISLAND GROUP ADMINSTRATIO
NY=========OtherPRISM HEALTH NETWORKS
NY=========OtherHEALTHCARE NETWORK AMERIC
NY=========OtherMULTIPLAN