Provider Demographics
NPI:1689175713
Name:LK THERAPY PT, OT AND SLP PLLC
Entity Type:Organization
Organization Name:LK THERAPY PT, OT AND SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-697-5064
Mailing Address - Street 1:41 COUNTY ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-3713
Mailing Address - Country:US
Mailing Address - Phone:845-697-5064
Mailing Address - Fax:845-697-5064
Practice Address - Street 1:41 COUNTY ROUTE 49
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-3713
Practice Address - Country:US
Practice Address - Phone:845-697-5064
Practice Address - Fax:845-697-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NY025596252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1487021242Medicaid
NY1871961946Medicaid
NY1043625148Medicaid
NY1104118462Medicaid
NY1811363393Medicaid
NY1326170986Medicaid
NY1720489040Medicaid
NY1922545938Medicaid