Devine Physical Therapy, Acupuncture and Massage Therapy, PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

DEVINE PHYSICAL THERAPY, ACUPUNCTURE AND MASSAGE THERAPY, PLLC

Practice address

10 Fort Salonga Rd Ste 2a
Fort Salonga, NY 11768-1400

Phone

(631) 320-1100

Fax

(631) 343-7174

NPI assigned

Jun 5, 2017

Last updated

May 3, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Olsen, P.T., D.P.T.NPI 1477614808

Title

Manager

Phone

(631) 320-1100

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Lynn Olsen, D.P.T.

  • Physical Therapist
  • Daniel Island, SC
  • NPI 1477614808
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556841600000",
    "number": "1952830960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PMB 373",
            "address_2": "186 SEVEN FARMS DRIVE, STE F",
            "city": "DANIEL ISLAND",
            "state": "SC",
            "postal_code": "29492",
            "telephone_number": "516-662-9962",
            "fax_number": "631-343-7174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FORT SALONGA RD STE 2A",
            "city": "FORT SALONGA",
            "state": "NY",
            "postal_code": "117681400",
            "telephone_number": "631-320-1100",
            "fax_number": "631-343-7174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "958 Portion Rd",
            "address_purpose": "LOCATION",
            "city": "Ronkonkoma",
            "state": "NY",
            "postal_code": "117791975",
            "country_code": "US",
            "telephone_number": "631-320-1100",
            "fax_number": "631-320-1099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DEVINE PHYSICAL THERAPY, ACUPUNCTURE AND MASSAGE THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-05",
        "last_updated": "2019-05-03",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "631-320-1100",
        "authorized_official_credential": "P.T., D.P.T."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Ann Attivissimo, PH.D.
• Jody Ellen Burke, LMSW
• Jeanne Edith D'Brant, DC, DACBN
• Anthony Alexander Degori
• Christen Marie Delillo
• Lillian Patricia Fais, M.A.
• Dennis Falco
• Suzanne Fischer, LMT
• Jeanine Harten, MA,OTR/L
• Ronita Adora Humphrey

• Multi-Specialty Clinic/Center in Fort Salonga, NY
• Providers in Fort Salonga, NY by specialty
• Multi-Specialty Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.