Provider Demographics
NPI:1255749727
Name:TOTAL PHYSICAL THERAPY OF MASSAPEQUA, PC
Entity type:Organization
Organization Name:TOTAL PHYSICAL THERAPY OF MASSAPEQUA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:516-586-4766
Mailing Address - Street 1:200 BOUNDARY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1152
Mailing Address - Country:US
Mailing Address - Phone:516-586-4766
Mailing Address - Fax:516-586-4758
Practice Address - Street 1:200 BOUNDARY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1152
Practice Address - Country:US
Practice Address - Phone:516-586-4766
Practice Address - Fax:516-586-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA4000407494Medicare PIN