Provider Demographics
NPI:1982809547
Name:THERAPEUTIC EXCELLENCE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:THERAPEUTIC EXCELLENCE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-365-2929
Mailing Address - Street 1:1350 NORTHERN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3004
Mailing Address - Country:US
Mailing Address - Phone:516-365-2929
Mailing Address - Fax:
Practice Address - Street 1:1350 NORTHERN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3004
Practice Address - Country:US
Practice Address - Phone:516-365-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAZ00867OtherMDNY
NY080005505NY02OtherANTHEM
NY2114203OtherAETNA US HEALTHCARE
NY0061101OtherHEALTHNET ORTHONET
PA66496OtherBLUE SHIELD PA
NYQ45771OtherBLUE SHIELD
NY169333POtherHIP
NY02008401OtherAETNA ORTHONET
NY5C7199OtherHEALTHNET
NYP1536005OtherOXFORD
NYQ45771OtherBLUE SHIELD ORTHONET
NYAZ00867OtherMDNY