Provider Demographics
NPI:1316417702
Name:MICHELLE DOXSEE PT PC
Entity type:Organization
Organization Name:MICHELLE DOXSEE PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOXSEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-513-7398
Mailing Address - Street 1:24 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1302
Mailing Address - Country:US
Mailing Address - Phone:631-513-7398
Mailing Address - Fax:
Practice Address - Street 1:157 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2016
Practice Address - Country:US
Practice Address - Phone:631-513-7398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04-3848958OtherTAX ID