Provider Demographics
NPI:1578689642
Name:LAWRENCE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:LAWRENCE PHYSICAL THERAPY, P.C.
Other - Org Name:ROCKAWAY PARK PHYSICAL THERAPY AND AQUATIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-797-8084
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-0437
Mailing Address - Country:US
Mailing Address - Phone:516-797-8088
Mailing Address - Fax:516-797-8092
Practice Address - Street 1:135 ROCKAWAY TPKE
Practice Address - Street 2:SUITE 107
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1023
Practice Address - Country:US
Practice Address - Phone:516-371-9622
Practice Address - Fax:516-239-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010666-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty