Provider Demographics
NPI:1821453572
Name:LIFETIME PHYSICAL THERAPY AND CHIROPRACTIC REHABILITATION PLLC
Entity Type:Organization
Organization Name:LIFETIME PHYSICAL THERAPY AND CHIROPRACTIC REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:LIPETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, OCS, CERTMDT
Authorized Official - Phone:516-513-1510
Mailing Address - Street 1:750 ZECKENDORF BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2133
Mailing Address - Country:US
Mailing Address - Phone:516-513-1510
Mailing Address - Fax:516-513-1511
Practice Address - Street 1:1000 ZECKENDORF BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2133
Practice Address - Country:US
Practice Address - Phone:516-513-1510
Practice Address - Fax:516-513-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN012560111N00000X
NY026960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty