Provider Demographics
NPI:1649676818
Name:LAKSHMI PT OT SLP MASSAGE CONSULTANTS PLLC
Entity type:Organization
Organization Name:LAKSHMI PT OT SLP MASSAGE CONSULTANTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-557-3207
Mailing Address - Street 1:7649 HEWLETT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1429
Mailing Address - Country:US
Mailing Address - Phone:718-343-5340
Mailing Address - Fax:
Practice Address - Street 1:7649 HEWLETT ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1429
Practice Address - Country:US
Practice Address - Phone:718-343-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018479174400000X
NY021687235Z00000X
NY023963-1174400000X
NY026741-1174400000X
NY022753-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty