Provider Demographics
NPI:1356981039
Name:PROFESSIONAL PT OT SERVICES P.L.L.C.
Entity type:Organization
Organization Name:PROFESSIONAL PT OT SERVICES P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MAHASE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-667-8844
Mailing Address - Street 1:500 DEKALB AVE STE 401B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-5243
Mailing Address - Country:US
Mailing Address - Phone:516-667-8844
Mailing Address - Fax:718-228-5233
Practice Address - Street 1:500 DEKALB AVE STE 401B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-5243
Practice Address - Country:US
Practice Address - Phone:516-667-8844
Practice Address - Fax:718-228-5233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL PT OT SERVICES P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-10
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty