Provider Demographics
NPI:1528281458
Name:PHYSICAL THERAPY EXPERIENCE PLLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY EXPERIENCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZION
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-724-5788
Mailing Address - Street 1:222 E MIDDLE COUNTRY RD STE 226
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2873
Mailing Address - Country:US
Mailing Address - Phone:631-724-5788
Mailing Address - Fax:631-724-5177
Practice Address - Street 1:222 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2871
Practice Address - Country:US
Practice Address - Phone:631-724-5788
Practice Address - Fax:631-724-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ3WXU1Medicare ID - Type Unspecified
NYQ07E11Medicare ID - Type Unspecified
NYQQ5141Medicare ID - Type Unspecified