Provider Demographics
NPI:1528135548
Name:PHYSICAL THERAPY AND SPORT SERVICES, P.C.
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND SPORT SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-622-0150
Mailing Address - Street 1:1373-28 VETERANS MEMORIAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:631-622-0150
Mailing Address - Fax:631-622-0152
Practice Address - Street 1:1373-28 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-622-0150
Practice Address - Fax:631-622-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1WXU1Medicare PIN