| Premier Physical Therapy Of Long Island Pc | |
| 1 Terry St, Patchogue, NY 11772-1720 | |
| (111) 111-1111 | |
| Not Available | 
| Full Name | Premier Physical Therapy Of Long Island Pc | 
|---|---|
| Type | Facility | 
| Speciality | Physical Therapist | 
| Location | 1 Terry St, Patchogue, New York | 
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1528351988 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 225100000X | Physical Therapist | 024794 (New York) | Primary | 
| Provider Name | Matthew D Angelillo | 
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice | 
| Provider Identifiers | NPI Number: 1104868298 PECOS PAC ID: 8729085436 Enrollment ID: I20061021000005 | 
| Provider Name | Heather A Angelillo | 
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional | 
| Provider Identifiers | NPI Number: 1205029956 PECOS PAC ID: 0345325403 Enrollment ID: I20080313000206 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Premier Physical Therapy Of Long Island Pc 84 Pacific Blvd, Long Beach, NY 11561-4700 Ph: (516) 698-2930 | Premier Physical Therapy Of Long Island Pc 1 Terry St, Patchogue, NY 11772-1720 Ph: (111) 111-1111 | 
| Ronald Amaya Lopez, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 322 W Main St, Patchogue, NY 11772 Phone: 631-228-4977 | |
| Sungguk Bae,  Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 21 Cleveland St, Patchogue, NY 11772 Phone: 631-569-9373 | |
| Nicole Marie Divirgilio, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 77 Route 112 Ste F, Patchogue, NY 11772 Phone: 631-207-2370 | |
| John Lowe Wilson, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 25 Theresa Ct, Patchogue, NY 11772 Phone: 631-730-3326 | |
| Danielle M Bousquet,  Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 77 Medford Ave, Patchogue, NY 11772 Phone: 631-758-1910 | |
| Stephanie Lauren Vanschaick, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 77 Medford Ave, Patchogue, NY 11772 Phone: 631-758-1910 Fax: 631-758-1984 | |
| Kathleen Alyssa Bailey, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 322 W Main St, Patchogue, NY 11772 Phone: 631-228-4977 |