Provider Demographics
NPI:1972747707
Name:LINDENHURST PT & PTA PLLC
Entity Type:Organization
Organization Name:LINDENHURST PT & PTA PLLC
Other - Org Name:LINDENHURST PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:516-454-6387
Mailing Address - Street 1:256 N WELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3707
Mailing Address - Country:US
Mailing Address - Phone:631-957-7300
Mailing Address - Fax:631-957-7024
Practice Address - Street 1:1061 N BROADWAY
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1853
Practice Address - Country:US
Practice Address - Phone:516-454-6387
Practice Address - Fax:516-454-6303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO COMPRENHENSIVE PHYSICAL & AQUATIC THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029487-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty