Provider Demographics
NPI:1144262601
Name:PANETTA PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:PANETTA PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PANETTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-665-4560
Mailing Address - Street 1:3385 VETERANS MEMORIAL HWY STE I
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7660
Mailing Address - Country:US
Mailing Address - Phone:631-665-4560
Mailing Address - Fax:631-665-7213
Practice Address - Street 1:3385 VETERANS MEMORIAL HWY STE I
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7660
Practice Address - Country:US
Practice Address - Phone:631-676-3111
Practice Address - Fax:631-676-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009077-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW98821Medicare PIN