Provider Demographics
NPI:1538110838
Name:T.L.C.PHYSICAL THERAPY,P.C.
Entity Type:Organization
Organization Name:T.L.C.PHYSICAL THERAPY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-863-1290
Mailing Address - Street 1:197 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1849
Mailing Address - Country:US
Mailing Address - Phone:631-863-1290
Mailing Address - Fax:631-863-3090
Practice Address - Street 1:197 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1849
Practice Address - Country:US
Practice Address - Phone:631-863-1290
Practice Address - Fax:631-863-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7W3U1Medicare PIN