Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dimitry Pettaway

Individual provider Physical Therapist · NPI 1154203164

Dimitry Pettaway is a Physical Therapist in Oceanside, New York. Practices as a sole proprietor. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

2837 Long Beach Rd
Oceanside, NY 11572-2233
Phone: (516) 461-6919
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1154203164
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 22, 2025
Last updated in NPPESJuly 22, 2025
Certification dateJuly 22, 2025
Mailing address576 Broadhollow Rd, Melville, NY 11747-5012

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