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General NPI Number Information
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NPI Number | 1285982835
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Entity Type | Organization
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Legal Business Name | R-EVOLVE PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 125 LAKE ST APT 8GN
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City | WHITE PLAINS
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State | NY
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Zip | 10604-2419
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Country | US
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Telephone | 518-669-1856
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Fax |
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Provider Business Mailing Address
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Address Line | 125 LAKE ST APT 8GN
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City | WHITE PLAINS
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State | NY
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Zip | 10604-2419
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Country | US
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Telephone | 518-669-1856
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ROBERT T LEMYRE
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Credential | DPT
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Telephone | 518-669-1856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 031217
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License Number State | NY
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