Provider Demographics
NPI: | 1790927184 |
---|---|
Name: | LIFELINE PHYSICAL THERAPY PLLC |
Entity Type: | Organization |
Organization Name: | LIFELINE PHYSICAL THERAPY PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR OF PHYSICAL THERAPY |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | NATALEE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 718-269-0030 |
Mailing Address - Street 1: | 150 CORBIN PL APT 3L |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11235-4828 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 347-526-4820 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 150 CORBIN PL APT 6C |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11235-4874 |
Practice Address - Country: | US |
Practice Address - Phone: | 347-526-4820 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-31 |
Last Update Date: | 2020-01-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 019879-1 | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |