Provider Demographics
NPI:1114447752
Name:XPERIENCE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:XPERIENCE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:914-882-0830
Mailing Address - Street 1:125 LAKE ST APT 8G-N
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2427
Mailing Address - Country:US
Mailing Address - Phone:914-882-0830
Mailing Address - Fax:914-479-0039
Practice Address - Street 1:444 S FULTON AVE
Practice Address - Street 2:GROUND FLOOR ACTIVE FITNESS
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1718
Practice Address - Country:US
Practice Address - Phone:914-882-0830
Practice Address - Fax:914-479-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-25
Last Update Date:2017-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty