Provider Demographics
NPI:1316556541
Name:LIC STRONG PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:LIC STRONG PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHOKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-328-8098
Mailing Address - Street 1:2728 THOMSON AVE UNIT 353
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2938
Mailing Address - Country:US
Mailing Address - Phone:917-328-8098
Mailing Address - Fax:
Practice Address - Street 1:4528 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5247
Practice Address - Country:US
Practice Address - Phone:917-328-8098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty