Provider Demographics
NPI:1205132602
Name:WISH PHYSICAL AND MASSAGE THERAPIES, PLLC
Entity type:Organization
Organization Name:WISH PHYSICAL AND MASSAGE THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-768-5334
Mailing Address - Street 1:16 HIGH OAK CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4257
Mailing Address - Country:US
Mailing Address - Phone:516-768-5334
Mailing Address - Fax:
Practice Address - Street 1:16 HIGH OAK CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4257
Practice Address - Country:US
Practice Address - Phone:516-768-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018565208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty