Provider Demographics
NPI:1669661211
Name:MID-ISLAND PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:MID-ISLAND PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTOLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:631-345-0073
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-0066
Mailing Address - Country:US
Mailing Address - Phone:631-345-0073
Mailing Address - Fax:631-345-2054
Practice Address - Street 1:1255 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2515
Practice Address - Country:US
Practice Address - Phone:631-345-0073
Practice Address - Fax:631-345-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021146208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW0W221Medicare PIN