Provider Demographics
NPI:1922313154
Name:LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB
Entity Type:Organization
Organization Name:LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB
Other - Org Name:MIDTOWN CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PT
Authorized Official - Phone:212-685-8113
Mailing Address - Street 1:317 MADISON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5201
Mailing Address - Country:US
Mailing Address - Phone:212-685-8113
Mailing Address - Fax:212-697-4541
Practice Address - Street 1:317 MADISON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5201
Practice Address - Country:US
Practice Address - Phone:212-685-8113
Practice Address - Fax:212-697-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ21H21Medicare PIN
NYQ0W241Medicare PIN