Provider Demographics
NPI:1982700944
Name:LCL PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LCL PHYSICAL THERAPY PC
Other - Org Name:ORANGE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT ORANGE PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LOEFFTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-342-5170
Mailing Address - Street 1:495 SCHUTT ROAD EXT
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2268
Mailing Address - Country:US
Mailing Address - Phone:845-342-5170
Mailing Address - Fax:845-343-3278
Practice Address - Street 1:495 SCHUTT ROAD EXT
Practice Address - Street 2:SUITE 9
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2268
Practice Address - Country:US
Practice Address - Phone:845-342-5170
Practice Address - Fax:845-343-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2WLM1Medicare UPIN