Provider Demographics
NPI:1780380840
Name:INTENT REHAB PERFORMANCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:INTENT REHAB PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-209-7431
Mailing Address - Street 1:34 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2230
Mailing Address - Country:US
Mailing Address - Phone:631-942-1472
Mailing Address - Fax:
Practice Address - Street 1:351 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2940
Practice Address - Country:US
Practice Address - Phone:631-209-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty