Provider Demographics
NPI:1184708695
Name:RUSS L'HOMMEDIEU PT, P.C.
Entity type:Organization
Organization Name:RUSS L'HOMMEDIEU PT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:L'HOMMEDIEU
Authorized Official - Suffix:
Authorized Official - Credentials:PTMA
Authorized Official - Phone:631-477-6035
Mailing Address - Street 1:985 CARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1624
Mailing Address - Country:US
Mailing Address - Phone:631-765-8069
Mailing Address - Fax:631-614-4291
Practice Address - Street 1:633 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-7013
Practice Address - Country:US
Practice Address - Phone:631-477-6035
Practice Address - Fax:631-614-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011600225100000X, 2251G0304X, 2251H1300X, 2251P0200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Not Answered2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman FactorsGroup - Multi-Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherPHYSICAL THERAPIST