Provider Demographics
NPI:1528125630
Name:OMNI PHYSICAL THERAPY
Entity type:Organization
Organization Name:OMNI PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:NIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-543-2227
Mailing Address - Street 1:26 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4014
Mailing Address - Country:US
Mailing Address - Phone:631-543-2227
Mailing Address - Fax:631-543-1223
Practice Address - Street 1:905 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3218
Practice Address - Country:US
Practice Address - Phone:631-543-2227
Practice Address - Fax:631-543-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty