Provider Demographics
NPI:1689641417
Name:LIFE PHYSICAL THERAPY & WELLNESS, P.C.
Entity Type:Organization
Organization Name:LIFE PHYSICAL THERAPY & WELLNESS, P.C.
Other - Org Name:JANET OTTAIANO, P.T.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTAIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-735-1018
Mailing Address - Street 1:2555 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2152
Mailing Address - Country:US
Mailing Address - Phone:516-735-1018
Mailing Address - Fax:516-735-3882
Practice Address - Street 1:2555 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2152
Practice Address - Country:US
Practice Address - Phone:516-735-1018
Practice Address - Fax:516-735-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009019-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0459251OtherCIGNA
NYP00170917OtherRAILROAD MEDICARE
NYHIP09396OtherHIP
NYP87110OtherOXFORD
NY21952OtherVYTRA
NY3C7290OtherHEALTHNET
NY608010600OtherDEPT OF LABOR - ACS
NYQ15Z71OtherBC/BS
NYHIP09396OtherHIP
NYQ15Z71OtherBC/BS
NY=========OtherMAGNACARE
NY=========OtherPHCS
NYP87110OtherOXFORD
NYHIP09396OtherHIP
NYP87110OtherOXFORD