Provider Demographics
NPI:1851643837
Name:MASSIMO, ELISE M (PT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:M
Last Name:MASSIMO
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:20 PEACHTREE CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4616
Mailing Address - Country:US
Mailing Address - Phone:631-467-3700
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:467 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-3021
Practice Address - Country:US
Practice Address - Phone:518-941-0958
Practice Address - Fax:518-941-0958
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
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Provider Licenses
StateLicense IDTaxonomies
NY014536-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist