Basic Information
| Provider Information | |||||||||
| NPI: | 1245503192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY OF LEWISBORO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 EXCHANGE PL | ||||||||
| Address2: | SUITE 1414 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100052701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124251060 | ||||||||
| FaxNumber: | 2124800108 | ||||||||
| Practice Location | |||||||||
| Address1: | 890 ROUTE 35 | ||||||||
| Address2: | |||||||||
| City: | CROSS RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105181139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147635941 | ||||||||
| FaxNumber: | 9147635332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2012 | ||||||||
| LastUpdateDate: | 02/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | WATERS | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4126543212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S.P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 024977 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.