Basic Information
| Provider Information | |||||||||
| NPI: | 1306448600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 576 BROADHOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117475002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313595859 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 COOK PLZ | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079401951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732956460 | ||||||||
| FaxNumber: | 9739434863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2020 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | HAGLUND | ||||||||
| AuthorizedOfficialFirstName: | TARYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6313595780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.