Provider Demographics
NPI:1508019753
Name:ROBERTSON, LYDIA P (MS, PT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:P
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3634
Mailing Address - Country:US
Mailing Address - Phone:516-489-6079
Mailing Address - Fax:
Practice Address - Street 1:929 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3634
Practice Address - Country:US
Practice Address - Phone:516-489-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist