Provider Demographics
NPI:1659631745
Name:REACH FOR THE STARS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:REACH FOR THE STARS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LUCCA
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:631-786-7911
Mailing Address - Street 1:48 NEIL DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1241
Mailing Address - Country:US
Mailing Address - Phone:631-786-7911
Mailing Address - Fax:
Practice Address - Street 1:48 NEIL DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1241
Practice Address - Country:US
Practice Address - Phone:631-786-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018817-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy