Provider Demographics
NPI:1659521979
Name:MONTALTO PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:MONTALTO PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MONTALTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-624-6739
Mailing Address - Street 1:123 SOUTH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2251
Mailing Address - Country:US
Mailing Address - Phone:516-624-6739
Mailing Address - Fax:
Practice Address - Street 1:123 SOUTH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2251
Practice Address - Country:US
Practice Address - Phone:516-624-6739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0190711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty