Provider Demographics
NPI:1477951622
Name:NEISEN, ANNIE (PT, DPT, WCS)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:NEISEN
Suffix:
Gender:F
Credentials:PT, DPT, WCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TEXACO AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2243
Mailing Address - Country:US
Mailing Address - Phone:320-420-2956
Mailing Address - Fax:
Practice Address - Street 1:95 HORSEBLOCK RD UNIT 6A
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-2301
Practice Address - Country:US
Practice Address - Phone:475-282-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MN10997225100000X
NY036466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist