Provider Demographics
NPI:1811152671
Name:SOUTH SHORE SI PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:SOUTH SHORE SI PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZASO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-227-0198
Mailing Address - Street 1:4870 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6322
Mailing Address - Country:US
Mailing Address - Phone:718-356-1337
Mailing Address - Fax:
Practice Address - Street 1:4870 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6322
Practice Address - Country:US
Practice Address - Phone:718-356-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016967-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy