=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437258233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKSHMI PT CONSULTANTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 09/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 MERRICK RD
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-442-1055
-----------------------------------------------------
Fax | 516-442-1056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 MERRICK RD
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-442-1055
-----------------------------------------------------
Fax | 516-442-1056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHANTI MUDUMBA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 516-442-1055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 023963-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------