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General NPI Number Information
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NPI Number | 1649676818
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Entity Type | Organization
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Legal Business Name | LAKSHMI PT OT SLP MASSAGE CONSULTANTS PLLC
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 509 MERRICK RD
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-5436
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Country | US
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Telephone | 516-442-1055
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Fax | 516-442-1056
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Provider Business Mailing Address
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Address Line | 509 MERRICK RD
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-5436
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Country | US
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Telephone | 516-442-1055
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Fax | 516-442-1056
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Authorized Official
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Title or Position | OWNER
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Name | SHANTI MUDUMBA
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Credential | PT
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Telephone | 516-442-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 023963-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 021687
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 018479
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 026741-1
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 022753-1
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License Number State | NY
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