Provider Demographics
NPI:1376146019
Name:LEMON CREEK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LEMON CREEK PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:FAHMY
Authorized Official - Last Name:TAWADROS DAWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHYSICAL T
Authorized Official - Phone:917-589-0684
Mailing Address - Street 1:318 SEGUINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3941
Mailing Address - Country:US
Mailing Address - Phone:718-356-9222
Mailing Address - Fax:
Practice Address - Street 1:318 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3941
Practice Address - Country:US
Practice Address - Phone:718-356-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty