Provider Demographics
NPI:1376649335
Name:LCL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LCL PHYSICAL THERAPY
Other - Org Name:ORANGE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LOEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-342-5170
Mailing Address - Street 1:18 RIDGE STREET
Mailing Address - Street 2:ORANGE PHYSICAL THERAPY
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-342-5170
Mailing Address - Fax:845-343-3278
Practice Address - Street 1:152 ORANGE AVENUE
Practice Address - Street 2:ORANGE PHYSICAL THERAPY
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586
Practice Address - Country:US
Practice Address - Phone:845-778-1552
Practice Address - Fax:845-778-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2WLM3Medicare ID - Type Unspecified