Provider Demographics
NPI:1639711682
Name:ASCENT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ASCENT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BERGHORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT, ATC, USAW
Authorized Official - Phone:516-287-3438
Mailing Address - Street 1:1631 LITTLE NECK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1809
Mailing Address - Country:US
Mailing Address - Phone:516-287-3438
Mailing Address - Fax:
Practice Address - Street 1:1631 LITTLE NECK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1809
Practice Address - Country:US
Practice Address - Phone:516-287-3438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy