Provider Demographics
NPI:1245503192
Name:PHYSICAL THERAPY OF LEWISBORO
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF LEWISBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:412-654-3212
Mailing Address - Street 1:40 EXCHANGE PL
Mailing Address - Street 2:SUITE 1414
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2701
Mailing Address - Country:US
Mailing Address - Phone:212-425-1060
Mailing Address - Fax:212-480-0108
Practice Address - Street 1:890 ROUTE 35
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1139
Practice Address - Country:US
Practice Address - Phone:914-763-5941
Practice Address - Fax:914-763-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty