Provider Demographics
NPI:1730341504
Name:ADVANCED PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CARR-MCCREIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:631-220-4234
Mailing Address - Street 1:346B LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2905
Mailing Address - Country:US
Mailing Address - Phone:631-623-6371
Mailing Address - Fax:631-623-6373
Practice Address - Street 1:346B LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2905
Practice Address - Country:US
Practice Address - Phone:631-623-6371
Practice Address - Fax:631-623-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010893-1225X00000X, 225XP0200X
NY014003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty