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General NPI Number Information
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NPI Number | 1093930554
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Entity Type | Individual
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Provider Name | LAURA LEI-RIVERA P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 310 E 14TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-4201
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Country | US
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Telephone | 212-979-4673
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Fax | 212-533-4371
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Provider Business Mailing Address
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Address Line | 37 MIDDLE LOOP RD
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City | STATEN ISLAND
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State | NY
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Zip | 10308-1922
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Country | US
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Telephone | 917-690-7463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 016925-1
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License Number State | NY
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