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General NPI Number Information
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NPI Number | 1699935866
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Entity Type | Individual
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Provider Name | CAROLYN REBECCA LACK DPT
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Gender | Female
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 147 W 24TH ST 7TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10011-1911
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Country | US
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Telephone | 212-997-7490
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Fax | 212-997-7492
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Provider Business Mailing Address
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Address Line | 50 LEXINGTON AVE APT 24A
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City | NEW YORK
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State | NY
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Zip | 10010-2935
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Country | US
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Telephone | 212-674-3231
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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 | 025886-1
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License Number State | NY
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