Provider Demographics
NPI:1255926283
Name:LOVERRO, CHRISTOPHER WILLIAM (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:LOVERRO
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4865
Mailing Address - Country:US
Mailing Address - Phone:516-524-0225
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4900
Practice Address - Country:US
Practice Address - Phone:631-542-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046612-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist