Provider Demographics
NPI:1629533773
Name:BALANCED GAIT PHYSICAL THERAPY P.C
Entity Type:Organization
Organization Name:BALANCED GAIT PHYSICAL THERAPY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-338-4073
Mailing Address - Street 1:2 DALTON CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4530
Mailing Address - Country:US
Mailing Address - Phone:631-338-4073
Mailing Address - Fax:631-873-4030
Practice Address - Street 1:160 COMMACK RD STE LL3
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3412
Practice Address - Country:US
Practice Address - Phone:631-338-4073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center