Basic Information
| Provider Information | |||||||||
| NPI: | 1245286806 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROBERT WILUTIS OCCUPATIONAL AND PHYSICAL THERAPY PLLC | ||||||||
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| OtherOrganizationName: | ROBERT WILUTIS HAND THERAPY PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 BELLE TERRE RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313608 | ||||||||
| FaxNumber: | 6313312392 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 BELLE TERRE RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313608 | ||||||||
| FaxNumber: | 6313312392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 06/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | WILUTIS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER SENIOR THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 6313313608 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MS OTR CHT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 0087371 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | QS4941 | 01 | NY | BCBS | OTHER |