Provider Demographics
NPI:1215470562
Name:BELLMORE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:BELLMORE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-785-1667
Mailing Address - Street 1:2566 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:N BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1832
Mailing Address - Country:US
Mailing Address - Phone:516-785-1667
Mailing Address - Fax:516-785-1668
Practice Address - Street 1:2566 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:N BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1832
Practice Address - Country:US
Practice Address - Phone:516-785-1667
Practice Address - Fax:516-785-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty