Provider Demographics
NPI:1659578763
Name:3-DIMENSIONAL PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:3-DIMENSIONAL PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTERES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-786-0788
Mailing Address - Street 1:16 MALER LANE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3158
Mailing Address - Country:US
Mailing Address - Phone:631-786-0788
Mailing Address - Fax:
Practice Address - Street 1:1745 UNION BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7952
Practice Address - Country:US
Practice Address - Phone:631-665-0634
Practice Address - Fax:631-665-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019516-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DPOQ01Q710Medicare PIN