Provider Demographics
NPI:1770644742
Name:CRS HOMEBASED PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:CRS HOMEBASED PHYSICAL THERAPY, P.C.
Other - Org Name:COMPLETE REHAB & SPORT
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SCHWENKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-654-5282
Mailing Address - Street 1:672 S COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5549
Mailing Address - Country:US
Mailing Address - Phone:631-654-5282
Mailing Address - Fax:631-654-5253
Practice Address - Street 1:672 S COUNTRY RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5549
Practice Address - Country:US
Practice Address - Phone:631-654-5282
Practice Address - Fax:631-654-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDB4769OtherRAIL ROAD MEDICARE
NYQ3W1E1Medicare ID - Type UnspecifiedGROUP MEDICARE IDENTIFIER