Provider Demographics
NPI:1962594143
Name:PKL PHYSICAL THERAPY & WELLNESS, PC
Entity type:Organization
Organization Name:PKL PHYSICAL THERAPY & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-691-6900
Mailing Address - Street 1:11 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2701
Mailing Address - Country:US
Mailing Address - Phone:631-691-6900
Mailing Address - Fax:631-691-6910
Practice Address - Street 1:11 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2701
Practice Address - Country:US
Practice Address - Phone:631-691-6900
Practice Address - Fax:631-691-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4W9A1Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER