Provider Demographics
NPI:1659518157
Name:PROFESSIONAL CARE PHYSICAL THERAPY AND REHABILITATION P.C
Entity Type:Organization
Organization Name:PROFESSIONAL CARE PHYSICAL THERAPY AND REHABILITATION P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CIRESI
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-775-0971
Mailing Address - Street 1:191 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4899
Mailing Address - Country:US
Mailing Address - Phone:631-775-0971
Mailing Address - Fax:631-475-0975
Practice Address - Street 1:191 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4899
Practice Address - Country:US
Practice Address - Phone:631-775-0971
Practice Address - Fax:631-475-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025766OtherLICENSE