| Organization Name: | ORTHOSPORT PHYSICAL THERAPY PC |
| NPI Number: | 1386650133 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTHONY DEROSA (OWNER) |
| Mailing Address: | 333 Route 25a Ste 240 Rocky Point |
| State: | NY US |
| Postal Code: | 117788556 |
| Phone Number: | 6318215500 |
| Fax Number: | 6318215580 |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 02/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 010676 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |