Provider Demographics
NPI:1891824322
Name:ECLIPSE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:ECLIPSE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLROOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-647-4171
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-0685
Mailing Address - Country:US
Mailing Address - Phone:845-647-4171
Mailing Address - Fax:845-647-4174
Practice Address - Street 1:6325 ROUTE 209
Practice Address - Street 2:
Practice Address - City:KERHONKSON
Practice Address - State:NY
Practice Address - Zip Code:12446
Practice Address - Country:US
Practice Address - Phone:845-647-4171
Practice Address - Fax:845-647-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5W5D1OtherPTAN