Provider Demographics
NPI:1427188440
Name:LEWISBORO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LEWISBORO PHYSICAL THERAPY PC
Other - Org Name:KATONAH PHYSICAL THERAPY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:412-654-3212
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0101
Mailing Address - Country:US
Mailing Address - Phone:338-887-8688
Mailing Address - Fax:833-888-7868
Practice Address - Street 1:190 GOLDENS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2804
Practice Address - Country:US
Practice Address - Phone:914-232-3306
Practice Address - Fax:914-232-4862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWISBORO PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100022894Medicare PIN