Provider Demographics
NPI:1477934537
Name:LIFESTYLE REHAB PT PC
Entity Type:Organization
Organization Name:LIFESTYLE REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-841-7392
Mailing Address - Street 1:45 LINDA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4750
Mailing Address - Country:US
Mailing Address - Phone:718-676-9679
Mailing Address - Fax:
Practice Address - Street 1:45 LINDA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4750
Practice Address - Country:US
Practice Address - Phone:718-676-9679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty