Provider Demographics
NPI:1699878058
Name:ULTIMATE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ULTIMATE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EXITO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-785-0101
Mailing Address - Street 1:2631 MERRICK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5784
Mailing Address - Country:US
Mailing Address - Phone:516-785-0101
Mailing Address - Fax:516-781-5706
Practice Address - Street 1:2631 MERRICK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5784
Practice Address - Country:US
Practice Address - Phone:516-785-0101
Practice Address - Fax:516-781-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0WGO1Medicare ID - Type UnspecifiedPHYSICAL THERAPY