Provider Demographics
NPI:1316965841
Name:HILL, BRETT (PT)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NEWHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5624
Mailing Address - Country:US
Mailing Address - Phone:631-813-2143
Mailing Address - Fax:800-552-6176
Practice Address - Street 1:165-58 BAISLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROCHDALE
Practice Address - State:NY
Practice Address - Zip Code:11434
Practice Address - Country:US
Practice Address - Phone:718-341-4431
Practice Address - Fax:888-732-0238
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ7731Medicare Oscar/Certification
NYQQ7731Medicare PIN