Provider Demographics
NPI:1760746713
Name:PPT THERAPIES OF WESTERN SUFFOLK PT OT SLP LLP
Entity Type:Organization
Organization Name:PPT THERAPIES OF WESTERN SUFFOLK PT OT SLP LLP
Other - Org Name:PPT THERAPIES OF WESTERN SUFFOLK
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOFMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:631-499-4344
Mailing Address - Street 1:77 VETERANS HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3410
Mailing Address - Country:US
Mailing Address - Phone:631-499-4344
Mailing Address - Fax:631-499-4383
Practice Address - Street 1:77 VETERANS HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3410
Practice Address - Country:US
Practice Address - Phone:631-499-4344
Practice Address - Fax:631-499-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management