Provider Demographics
NPI:1891708301
Name:SALL, DENNIS PATRICK (DPT, DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PATRICK
Last Name:SALL
Suffix:
Gender:M
Credentials:DPT, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1623
Mailing Address - Country:US
Mailing Address - Phone:631-476-4600
Mailing Address - Fax:631-476-8236
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1623
Practice Address - Country:US
Practice Address - Phone:631-476-4600
Practice Address - Fax:631-476-8236
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0098411111N00000X
NY032930-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX9C511Medicare ID - Type Unspecified
U81990Medicare UPIN