Basic Information
| Provider Information | |||||||||
| NPI: | 1427188440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEWISBORO PHYSICAL THERAPY PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KATONAH PHYSICAL THERAPY PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 101 | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300240101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3388878688 | ||||||||
| FaxNumber: | 8338887868 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 GOLDENS BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105362804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142323306 | ||||||||
| FaxNumber: | 9142324862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WATERS | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4126543212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEWISBORO PHYSICAL THERAPY | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.S.P.T. | ||||||||
| NPICertificationDate: | |||||||||
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.