Provider Demographics
NPI:1225046899
Name:LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB, P.C.
Entity Type:Organization
Organization Name:LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:412-654-3212
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0101
Mailing Address - Country:US
Mailing Address - Phone:678-571-3852
Mailing Address - Fax:833-888-7868
Practice Address - Street 1:40 EXCHANGE PL
Practice Address - Street 2:SUITE 728
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2701
Practice Address - Country:US
Practice Address - Phone:212-425-1060
Practice Address - Fax:646-527-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6497480001Medicare NSC
NYQ0W241Medicare PIN