Provider Demographics
NPI:1528831740
Name:PRESCRIPTION EXERCISE LLC
Entity type:Organization
Organization Name:PRESCRIPTION EXERCISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-445-8799
Mailing Address - Street 1:6 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3364
Mailing Address - Country:US
Mailing Address - Phone:631-509-0910
Mailing Address - Fax:631-509-0911
Practice Address - Street 1:6 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3364
Practice Address - Country:US
Practice Address - Phone:631-509-0910
Practice Address - Fax:631-509-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty