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General NPI Number Information
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NPI Number | 1023533619
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Entity Type | Organization
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Legal Business Name | LIFESTYLE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 1384 BROADWAY STE 606
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City | NEW YORK
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State | NY
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Zip | 10018-6108
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Country | US
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Telephone | 631-896-3821
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Fax |
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Provider Business Mailing Address
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Address Line | 1384 BROADWAY STE 606
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City | NEW YORK
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State | NY
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Zip | 10018-6108
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Country | US
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Telephone | 212-302-0141
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Fax | 212-302-0153
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW SELTZER
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Credential | DPT
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Telephone | 212-302-0141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 038508-1
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License Number State | NY
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