Provider Demographics
NPI:1508018318
Name:ADVANCED PHYSICAL THERAPY OF MERRICK, PC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY OF MERRICK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-295-1025
Mailing Address - Street 1:320 POST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2257
Mailing Address - Country:US
Mailing Address - Phone:516-333-7600
Mailing Address - Fax:516-279-6979
Practice Address - Street 1:320 POST AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2257
Practice Address - Country:US
Practice Address - Phone:516-333-7600
Practice Address - Fax:516-279-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0286572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty