Provider Demographics
NPI:1740846443
Name:FIRE ISLAND PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:FIRE ISLAND PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-300-8787
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:OCEAN BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11770-0328
Mailing Address - Country:US
Mailing Address - Phone:631-300-8787
Mailing Address - Fax:631-532-4012
Practice Address - Street 1:786 EVERGREEN WALK
Practice Address - Street 2:
Practice Address - City:OCEAN BEACH
Practice Address - State:NY
Practice Address - Zip Code:11770-2025
Practice Address - Country:US
Practice Address - Phone:631-300-8787
Practice Address - Fax:631-532-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036507Medicaid