Healthcare Provider Details

I. General information

NPI: 1902089279
Provider Name (Legal Business Name): LIVE STRONG PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 ARLEIGH DR
ALBERTSON NY
11507-1207
US

IV. Provider business mailing address

77 ARLEIGH DR
ALBERTSON NY
11507-1207
US

V. Phone/Fax

Practice location:
  • Phone: 917-596-6925
  • Fax:
Mailing address:
  • Phone: 917-596-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number028019-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. FARBOD BARZIDEH
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 917-596-6925