Provider Demographics
NPI:1659194710
Name:HOLISTIC FUNCTION AND REHABILITATION SERVICES LLC
Entity type:Organization
Organization Name:HOLISTIC FUNCTION AND REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SECRETO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:631-921-1215
Mailing Address - Street 1:209 POINTE CIR N
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1543
Mailing Address - Country:US
Mailing Address - Phone:631-921-1215
Mailing Address - Fax:
Practice Address - Street 1:209 POINTE CIR N
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1543
Practice Address - Country:US
Practice Address - Phone:631-921-1215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation