Provider Demographics
NPI:1225266448
Name:LAVOSKY PHYSICAL THERAPY & CONSULTING, LLC
Entity Type:Organization
Organization Name:LAVOSKY PHYSICAL THERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:862-926-9210
Mailing Address - Street 1:42 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3440
Mailing Address - Country:US
Mailing Address - Phone:973-744-3555
Mailing Address - Fax:
Practice Address - Street 1:42 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3440
Practice Address - Country:US
Practice Address - Phone:973-744-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00497700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067262Medicare UPIN