Provider Demographics
NPI:1538286885
Name:NASSAU SPORTS CARE WELLNESS & FITNESS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:NASSAU SPORTS CARE WELLNESS & FITNESS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KRUPA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:516-326-7899
Mailing Address - Street 1:1204 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4607
Mailing Address - Country:US
Mailing Address - Phone:516-326-7899
Mailing Address - Fax:516-326-7895
Practice Address - Street 1:1204 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4607
Practice Address - Country:US
Practice Address - Phone:516-326-7899
Practice Address - Fax:516-326-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty