Provider Demographics
NPI:1184929440
Name:ALL-STAR PHYSCIAL THERAPY OF SEAFORD P.C.
Entity type:Organization
Organization Name:ALL-STAR PHYSCIAL THERAPY OF SEAFORD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-802-2895
Mailing Address - Street 1:3839 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2839
Mailing Address - Country:US
Mailing Address - Phone:516-802-2895
Mailing Address - Fax:516-802-2897
Practice Address - Street 1:3839 MERRICK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2839
Practice Address - Country:US
Practice Address - Phone:516-802-2895
Practice Address - Fax:516-802-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021476261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy