Provider Demographics
NPI:1679679419
Name:SOUNDSIDE PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:SOUNDSIDE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAFFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-759-9717
Mailing Address - Street 1:146 BIRCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1833
Mailing Address - Country:US
Mailing Address - Phone:516-759-9717
Mailing Address - Fax:516-759-1666
Practice Address - Street 1:146 BIRCH HILL RD
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-1833
Practice Address - Country:US
Practice Address - Phone:516-759-9717
Practice Address - Fax:516-759-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1WET1Medicare ID - Type Unspecified