Provider Demographics
NPI:1578770848
Name:ALL ISLAND PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ALL ISLAND PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:631-246-6320
Mailing Address - Street 1:8 CATERHAM LN
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1945
Mailing Address - Country:US
Mailing Address - Phone:631-246-6320
Mailing Address - Fax:
Practice Address - Street 1:5380 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2056
Practice Address - Country:US
Practice Address - Phone:631-474-4096
Practice Address - Fax:631-474-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114526261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ44073Medicare ID - Type UnspecifiedPHYSICAL THERAPY