Provider Demographics
NPI:1427128081
Name:WORMOLD, TONI (PT)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:
Last Name:WORMOLD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 RIVERHEAD RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1401
Mailing Address - Country:US
Mailing Address - Phone:631-288-7767
Mailing Address - Fax:631-288-7100
Practice Address - Street 1:74 RIVERHEAD RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1401
Practice Address - Country:US
Practice Address - Phone:631-288-7767
Practice Address - Fax:631-288-7100
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018611-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY58418OtherVYTRA
NYAZ00175OtherMDNY
NY2365871OtherAETNA
NY6698016OtherGHI
NY018611OtherHIP
NY00274406Medicaid
NY015752-A64OtherHEALTHFIRST
NY32803OtherCIGNA
NYQH5392OtherBCBS
NY32803OtherU S FAMILY HEALTH
NY330-340Medicare ID - Type UnspecifiedSHH SPORTS REHAB WH