Provider Demographics
NPI:1568540045
Name:SPORTS PHYSICAL THERAPY EAST, PC
Entity Type:Organization
Organization Name:SPORTS PHYSICAL THERAPY EAST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CHERILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:631-375-4626
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:518 MONTAUK HWY
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-1560
Mailing Address - Country:US
Mailing Address - Phone:631-267-9100
Mailing Address - Fax:631-267-9111
Practice Address - Street 1:518 MONTAUK HWY
Practice Address - Street 2:STE 101
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930
Practice Address - Country:US
Practice Address - Phone:631-267-9100
Practice Address - Fax:631-267-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty