Basic Information
| Provider Information | |||||||||
| NPI: | 1902399124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEFORCE | ||||||||
| FirstName: | AUSTIN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1377 MOTOR PKWY STE 307 | ||||||||
| Address2: | |||||||||
| City: | ISLANDIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117495258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1631580520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 439 CHANNEL RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297106101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037467800 | ||||||||
| FaxNumber: | 8037467807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.