Provider Demographics
NPI:1154352888
Name:GENERATIONS PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:GENERATIONS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-661-3700
Mailing Address - Street 1:400 MONTAUK HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4208
Mailing Address - Country:US
Mailing Address - Phone:631-661-3700
Mailing Address - Fax:631-661-3749
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4208
Practice Address - Country:US
Practice Address - Phone:631-661-3700
Practice Address - Fax:631-661-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X, 261QP2000X
NY7484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ8WRQ1Medicare Oscar/Certification
NYQ8WRQ1Medicare PIN