Provider Demographics
NPI:1689790479
Name:MAHOPAC PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:MAHOPAC PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:845-628-5578
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-0940
Mailing Address - Country:US
Mailing Address - Phone:845-628-5578
Mailing Address - Fax:845-628-1654
Practice Address - Street 1:880 S LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4765
Practice Address - Country:US
Practice Address - Phone:845-628-5578
Practice Address - Fax:845-628-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ59791Medicare ID - Type Unspecified