Provider Demographics
NPI:1629105143
Name:COMPLETE REHABILITATION PT, OT, SLP OF THE HAMPTONS, PLLC
Entity Type:Organization
Organization Name:COMPLETE REHABILITATION PT, OT, SLP OF THE HAMPTONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEIM
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:631-325-6963
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:REMSENBURG
Mailing Address - State:NY
Mailing Address - Zip Code:11960-1025
Mailing Address - Country:US
Mailing Address - Phone:631-325-6963
Mailing Address - Fax:631-325-2941
Practice Address - Street 1:41 CEDAR LANE
Practice Address - Street 2:
Practice Address - City:REMSENBURG
Practice Address - State:NY
Practice Address - Zip Code:11960-1025
Practice Address - Country:US
Practice Address - Phone:631-325-6963
Practice Address - Fax:631-325-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3308-12251P0200X, 225XP0200X
NY0038-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty