Your browser does not support javascript. This is required for using the requested form.
First Name: *
Last Name: *
Address: *
Phone Number: *
E-mail:
New Patient
Existing Patient
Free assessment
Select a Therapist:
Select a Therapist
Mark Diaz, MS, PT
Ronald Bredow, MS, PT
Matthew Perry, DPT
Patrick Vignona III, MS, PT
Flora Villanea, PT
Desiree McConnon, MS, PT
Peter Lananna, PTA
Tara Gorman, PTA
Lina Salazar, PTA
no preference
Select a Location: *
Select a Location
820 Hempstead Turnpike, Franklin Square, NY 11010
150 Gardiners Avenue, Levittown, NY 11756
2088 Front Street, East Meadow, NY 11554
535 Broadhollow Road, Melville, NY 11747
Type of Appointment:
Follow Up
New Problem (Describe problem)
Desired Day/Date:
mm/dd/yyyy
Desired Time:
* = Input is required