Provider Demographics
NPI:1750761730
Name:JL HOME PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:JL HOME PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPIEZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:631-343-3147
Mailing Address - Street 1:PO BOX 2238
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-0608
Mailing Address - Country:US
Mailing Address - Phone:631-343-3147
Mailing Address - Fax:631-343-3148
Practice Address - Street 1:82 HOBSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3028
Practice Address - Country:US
Practice Address - Phone:631-343-3147
Practice Address - Fax:631-343-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty