Provider Demographics
NPI:1245286806
Name:ROBERT WILUTIS OCCUPATIONAL AND PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:ROBERT WILUTIS OCCUPATIONAL AND PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER SENIOR THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR CHT
Authorized Official - Phone:631-331-3608
Mailing Address - Street 1:635 BELLE TERRE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-331-3608
Mailing Address - Fax:631-331-2392
Practice Address - Street 1:635 BELLE TERRE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-331-3608
Practice Address - Fax:631-331-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY0087371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQS4941OtherBCBS
NYQS4941OtherBCBS