Provider Demographics
NPI:1013155746
Name:ULTRA HEALTH PT & PTA, PLLC
Entity Type:Organization
Organization Name:ULTRA HEALTH PT & PTA, PLLC
Other - Org Name:ULTRA HEALTH PHYSICAL & AQUATIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:KALTEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:631-328-5920
Mailing Address - Street 1:53 BRENTWOOD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6923
Mailing Address - Country:US
Mailing Address - Phone:631-328-5920
Mailing Address - Fax:631-328-5921
Practice Address - Street 1:53 BRENTWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6923
Practice Address - Country:US
Practice Address - Phone:631-328-5920
Practice Address - Fax:631-328-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021499-1225100000X
NY003072-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN3581Medicare PIN