Provider Demographics
NPI:1780983650
Name:POSITIVE OUTCOME PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:POSITIVE OUTCOME PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT/ CIMI /OSC
Authorized Official - Phone:631-543-6765
Mailing Address - Street 1:137 HARNED RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4203
Mailing Address - Country:US
Mailing Address - Phone:631-543-6765
Mailing Address - Fax:631-543-0612
Practice Address - Street 1:137 HARNED RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4203
Practice Address - Country:US
Practice Address - Phone:631-543-6765
Practice Address - Fax:631-543-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
OCCUPATIONAL THERAPY252Y00000X
SPEECH THERAPY252Y00000X
NYPHYSTHERAPY-004015252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency