Provider Demographics
NPI:1457342552
Name:HOME PHYSICAL THERAPY AND WELLNESS, P.C.
Entity Type:Organization
Organization Name:HOME PHYSICAL THERAPY AND WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LORI
Authorized Official - Last Name:HERR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-694-4426
Mailing Address - Street 1:54 WASHINGTON ST
Mailing Address - Street 2:NASSAU COUNTY
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2639
Mailing Address - Country:US
Mailing Address - Phone:516-694-4426
Mailing Address - Fax:516-694-4426
Practice Address - Street 1:54 WASHINGTON ST
Practice Address - Street 2:NASSAU COUNTY
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2639
Practice Address - Country:US
Practice Address - Phone:516-694-4426
Practice Address - Fax:516-694-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-30
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1W1W1Medicare PIN