Provider Demographics
NPI:1558403980
Name:LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB., P.C.
Entity Type:Organization
Organization Name:LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB., P.C.
Other - Org Name:YORKVILLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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:MS,PT
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:678-571-3852
Mailing Address - Fax:833-888-7868
Practice Address - Street 1:177 E 87TH ST # 405
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2226
Practice Address - Country:US
Practice Address - Phone:212-249-0904
Practice Address - Fax:646-527-9021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0W241Medicare PIN