Provider Demographics
NPI:1053488254
Name:ROBERTSON, LYNN P (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:P
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:P
Other - Last Name:SADOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1655 RICHMOND AVE
Mailing Address - Street 2:SUITE B102
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1570
Mailing Address - Country:US
Mailing Address - Phone:718-370-3500
Mailing Address - Fax:718-370-9724
Practice Address - Street 1:2183A RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5405
Practice Address - Country:US
Practice Address - Phone:718-451-1400
Practice Address - Fax:718-451-2797
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018856-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QL7341Medicare ID - Type Unspecified