Healthcare Provider Details

I. General information

NPI: 1669401717
Provider Name (Legal Business Name): L I PHYSICAL THERAPY & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 OLD COUNTRY RD
PLAINVIEW NY
11803-4924
US

IV. Provider business mailing address

516 OLD COUNTRY RD
PLAINVIEW NY
11803-4924
US

V. Phone/Fax

Practice location:
  • Phone: 516-433-6662
  • Fax: 516-433-6665
Mailing address:
  • Phone: 516-433-6662
  • Fax: 516-433-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18666
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10424
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. ROBERT SAMUEL LASSIG
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 516-433-6662