Provider Demographics
NPI:1104476449
Name:GOAL PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:GOAL PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:LETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-404-8052
Mailing Address - Street 1:91 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1126
Mailing Address - Country:US
Mailing Address - Phone:516-404-8052
Mailing Address - Fax:
Practice Address - Street 1:6 GRAMATAN AVE STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3209
Practice Address - Country:US
Practice Address - Phone:516-404-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty