Provider Demographics
NPI:1831442797
Name:CENTRAL VALLEY STREAM PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:CENTRAL VALLEY STREAM PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:516-825-1112
Mailing Address - Street 1:20 W LINCOLN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5731
Mailing Address - Country:US
Mailing Address - Phone:516-825-1112
Mailing Address - Fax:516-256-0503
Practice Address - Street 1:20 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5730
Practice Address - Country:US
Practice Address - Phone:516-825-1112
Practice Address - Fax:516-256-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty