Provider Demographics
NPI:1972633832
Name:SOUND BODY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SOUND BODY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ECKARDT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-943-8632
Mailing Address - Street 1:49 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-4210
Mailing Address - Country:US
Mailing Address - Phone:631-943-8632
Mailing Address - Fax:631-539-4462
Practice Address - Street 1:49 LEE AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-4210
Practice Address - Country:US
Practice Address - Phone:631-943-8632
Practice Address - Fax:631-539-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018173-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1972633832OtherNPI
NYQAWQR1Medicare ID - Type UnspecifiedPHYSICAL THERAPIST