Provider Demographics
NPI:1649687708
Name:PERSONAL TOUCH REHABILITATION PT, PLLC
Entity type:Organization
Organization Name:PERSONAL TOUCH REHABILITATION PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING EMPLOYEE
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:CONZO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:631-320-3603
Mailing Address - Street 1:243 BOYLE RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1929
Mailing Address - Country:US
Mailing Address - Phone:631-320-3603
Mailing Address - Fax:
Practice Address - Street 1:243 BOYLE RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1929
Practice Address - Country:US
Practice Address - Phone:631-320-3603
Practice Address - Fax:631-320-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018199-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty