Provider Demographics
NPI:1922323351
Name:ISLAND REGIONAL PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ISLAND REGIONAL PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDANILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:631-666-4600
Mailing Address - Street 1:1766 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6042
Mailing Address - Country:US
Mailing Address - Phone:631-666-4600
Mailing Address - Fax:631-666-4605
Practice Address - Street 1:1766 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6042
Practice Address - Country:US
Practice Address - Phone:631-666-4600
Practice Address - Fax:631-666-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty