Provider Demographics
NPI:1558784272
Name:PANETTA-YOUNG, THERESE M (DPT)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:PANETTA-YOUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HOWELLS RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5319
Mailing Address - Country:US
Mailing Address - Phone:631-665-4560
Mailing Address - Fax:631-665-7213
Practice Address - Street 1:225 HOWELLS RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5319
Practice Address - Country:US
Practice Address - Phone:631-665-4560
Practice Address - Fax:631-665-7213
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist