Basic Information
| Provider Information | |||||||||
| NPI: | 1457672511 | ||||||||
| EntityType: | 2 | ||||||||
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| 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: | 117771935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313608 | ||||||||
| FaxNumber: | 6313313608 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 BELLE TERRE RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313608 | ||||||||
| FaxNumber: | 6313313608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2010 | ||||||||
| LastUpdateDate: | 06/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | WILUTIS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6313313608 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR, CHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 008737 | NY | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 4823760001 | 01 | NY | DME NSC | OTHER |