Provider Demographics
NPI:1952700387
Name:PHYSI-CARE PT PC
Entity Type:Organization
Organization Name:PHYSI-CARE PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:TIMTIMAN
Authorized Official - Last Name:CABANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-747-9876
Mailing Address - Street 1:11 BYRD CT
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4511
Mailing Address - Country:US
Mailing Address - Phone:718-316-7296
Mailing Address - Fax:631-663-3820
Practice Address - Street 1:2171 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2937
Practice Address - Country:US
Practice Address - Phone:631-747-9876
Practice Address - Fax:516-427-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty