1831260504 NPI number — THREE VILLAGE PHYSICAL THERAPY PLLC

Table of content: (NPI 1831260504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831260504 NPI number — THREE VILLAGE PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE VILLAGE 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:
Provider Other Organization Name Type Code:
6
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:
1831260504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 OUTPOST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILTON HEAD ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29928-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-355-2120
Provider Business Mailing Address Fax Number:
843-686-4000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-355-2120
Provider Business Practice Location Address Fax Number:
843-686-4000
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAYTON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-355-2120

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  014253-1 , 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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