Provider Demographics
NPI:1134363229
Name:JELAINE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:JELAINE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-765-9230
Mailing Address - Street 1:1635 SHIPS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-3929
Mailing Address - Country:US
Mailing Address - Phone:631-765-9230
Mailing Address - Fax:
Practice Address - Street 1:1635 SHIPS DR
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-3929
Practice Address - Country:US
Practice Address - Phone:631-765-9230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health