1114263308 NPI number — EAST HAMPTON PHYSICAL THERAPY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114263308 NPI number — EAST HAMPTON PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST HAMPTON PHYSICAL THERAPY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EH PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114263308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 S ELMWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTAUK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11954-5421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-668-7600
Provider Business Mailing Address Fax Number:
631-668-7603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 S ELMWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTAUK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11954-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-668-7600
Provider Business Practice Location Address Fax Number:
631-668-7603
Provider Enumeration Date:
12/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LYS
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
631-668-7600

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  027331-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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