Provident Physical and Occupational Therapy Pllc

NPI #1144742479 in East Northport, New York

Provider Information

NPI Number: 1144742479
Entity Type: Organization
Organization Name: Provident Physical and Occupational Therapy Pllc
Primary Specialty: Physical Therapist
Enumeration Date: Jul 7, 2017
Last Updated: Jul 7, 2017

Practice Location

Address: 554 LARKFIELD RD STE 207
City: East Northport
State: New York
ZIP Code: 11731-4205
Phone: (631) 266-4501

Authorized Official

Name: MR. STEVEN C DESOUSA, PT, DPT, MA, OCS
Title: OWNER/ PT
Phone: (631) 266-4501

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Physical Therapist	225100000X	Primary

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