Provider Demographics
NPI:1851683692
Name:ACCEL PHYSICAL THERAPY WELLNESS PC
Entity Type:Organization
Organization Name:ACCEL PHYSICAL THERAPY WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEOGRANDE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSPT
Authorized Official - Phone:516-996-1179
Mailing Address - Street 1:85 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2811
Mailing Address - Country:US
Mailing Address - Phone:516-996-1179
Mailing Address - Fax:
Practice Address - Street 1:85 NASSAU ST
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2811
Practice Address - Country:US
Practice Address - Phone:516-996-1179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ51201Medicare PIN