Provider Demographics
NPI:1053514067
Name:ALL ISLAND PHYISCAL THERAPY
Entity type:Organization
Organization Name:ALL ISLAND PHYISCAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:631-246-6320
Mailing Address - Street 1:8 CATERHAM LN
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1945
Mailing Address - Country:US
Mailing Address - Phone:631-246-6320
Mailing Address - Fax:
Practice Address - Street 1:30 ROUTE 111
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3713
Practice Address - Country:US
Practice Address - Phone:631-724-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ44071Medicare ID - Type UnspecifiedPHYSICAL THERAPY