Provider Demographics
NPI:1912194606
Name:PHYSICAL THERAPY REHAB@HOME PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY REHAB@HOME PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-996-4783
Mailing Address - Street 1:36 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1742
Mailing Address - Country:US
Mailing Address - Phone:516-996-4783
Mailing Address - Fax:516-676-8666
Practice Address - Street 1:36 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1742
Practice Address - Country:US
Practice Address - Phone:516-996-4783
Practice Address - Fax:516-676-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005016OtherNYS LICENSE