Provider Demographics
NPI:1689966178
Name:FIRST STEP PHYSICAL THERAPY OF LONG ISLAND
Entity type:Organization
Organization Name:FIRST STEP PHYSICAL THERAPY OF LONG ISLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYSAGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:631-923-2288
Mailing Address - Street 1:900 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 WALT WHITMAN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2293
Practice Address - Country:US
Practice Address - Phone:631-923-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300025474OtherMEDICARE PTAN