Provider Demographics
NPI:1780870758
Name:POWERS PHYSIO-FIT PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:POWERS PHYSIO-FIT PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT,MS
Authorized Official - Phone:631-444-5603
Mailing Address - Street 1:128 OLD TOWN RD
Mailing Address - Street 2:SETAUKET OFFICE PARK(LOWER LEVEL)
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2064
Mailing Address - Country:US
Mailing Address - Phone:631-444-5603
Mailing Address - Fax:631-444-5604
Practice Address - Street 1:128 OLD TOWN RD
Practice Address - Street 2:SETAUKET OFFICE PARK(LOWER LEVEL)
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2064
Practice Address - Country:US
Practice Address - Phone:631-444-5603
Practice Address - Fax:631-444-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008596-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP3471Medicare PIN