Provider Demographics
NPI:1518138452
Name:BETHPAGE PHYSICAL THERAPY ASSOC PC
Entity Type:Organization
Organization Name:BETHPAGE PHYSICAL THERAPY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-579-7870
Mailing Address - Street 1:4250 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5711
Mailing Address - Country:US
Mailing Address - Phone:516-579-7870
Mailing Address - Fax:516-579-7867
Practice Address - Street 1:4250 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 1
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5711
Practice Address - Country:US
Practice Address - Phone:516-579-7870
Practice Address - Fax:516-579-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WTV1Medicare UPIN