Provider Demographics
NPI:1669401717
Name:L I PHYSICAL THERAPY & WELLNESS PLLC
Entity type:Organization
Organization Name:L I PHYSICAL THERAPY & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:LASSIG
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:516-433-6662
Mailing Address - Street 1:516 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4924
Mailing Address - Country:US
Mailing Address - Phone:516-433-6662
Mailing Address - Fax:516-433-6665
Practice Address - Street 1:516 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4924
Practice Address - Country:US
Practice Address - Phone:516-433-6662
Practice Address - Fax:516-433-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18666225100000X
NY10424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQOW011Medicare ID - Type Unspecified