Provider Demographics
NPI:1609804277
Name:LAFAYETTE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:LAFAYETTE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:YANKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-677-9323
Mailing Address - Street 1:2390 RT 11 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084
Mailing Address - Country:US
Mailing Address - Phone:315-677-9323
Mailing Address - Fax:315-677-9325
Practice Address - Street 1:2390 RT 11 SOUTH
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084
Practice Address - Country:US
Practice Address - Phone:315-677-9323
Practice Address - Fax:315-677-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXXXX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA0759Medicare PIN