Provider Demographics
NPI:1790938959
Name:LU, BEVERLY P (PT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:P
Last Name:LU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 VAN NOSTRAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3210
Mailing Address - Country:US
Mailing Address - Phone:845-255-0148
Mailing Address - Fax:845-255-0148
Practice Address - Street 1:85 VAN NOSTRAND RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3210
Practice Address - Country:US
Practice Address - Phone:845-255-0148
Practice Address - Fax:845-255-0148
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003808-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics