Provider Demographics
NPI:1629654645
Name:BLUE PT PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:BLUE PT PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGLIVIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-888-4342
Mailing Address - Street 1:155 W SUNRISE HWY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2434
Mailing Address - Country:US
Mailing Address - Phone:631-592-1500
Mailing Address - Fax:
Practice Address - Street 1:155 W SUNRISE HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2434
Practice Address - Country:US
Practice Address - Phone:631-592-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-21
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy