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General NPI Number Information
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NPI Number | 1659867604
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Entity Type | Organization
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Legal Business Name | THE PHYSICAL THERAPY PRACTICE
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 361 W 30TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10001-2749
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Country | US
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Telephone | 646-761-8123
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Fax |
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Provider Business Mailing Address
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Address Line | 361 W 30TH ST APT 1B
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City | NEW YORK
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State | NY
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Zip | 10001-2749
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Country | US
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Telephone | 646-761-8123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN JAMES LAVENDER
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Credential | PT
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Telephone | 646-761-8123
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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 |
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License Number State |
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