Provider Demographics
NPI:1346859493
Name:INSPIRE PHYSICAL THERAPY WELLNESS PLLC
Entity Type:Organization
Organization Name:INSPIRE PHYSICAL THERAPY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-251-0690
Mailing Address - Street 1:1397 E SALLY CT
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4520
Mailing Address - Country:US
Mailing Address - Phone:347-251-0690
Mailing Address - Fax:
Practice Address - Street 1:9112 175TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5571
Practice Address - Country:US
Practice Address - Phone:347-251-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty