Provider Demographics
NPI:1710634829
Name:SOUNDPORT PT, PC
Entity Type:Organization
Organization Name:SOUNDPORT PT, PC
Other - Org Name:SOUNDSIDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KALENDERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-759-9717
Mailing Address - Street 1:713 WALT WHITMAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2219
Mailing Address - Country:US
Mailing Address - Phone:631-425-5900
Mailing Address - Fax:631-424-9850
Practice Address - Street 1:713 WALT WHITMAN RD STE B
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2219
Practice Address - Country:US
Practice Address - Phone:631-425-5900
Practice Address - Fax:631-424-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty