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General NPI Number Information
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NPI Number | 1720436769
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Entity Type | Organization
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Legal Business Name | WILMER LACSON REHAB SERVICES,INC.
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 66 CRISFIELD ST UNIT 1Q
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City | YONKERS
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State | NY
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Zip | 10710-1243
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Country | US
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Telephone | 917-484-1465
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Fax |
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Provider Business Mailing Address
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Address Line | 315 E 108TH ST APT 2C
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City | NEW YORK
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State | NY
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Zip | 10029-4245
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Country | US
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Telephone | 917-484-1465
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. WILMER AVANCY LACSON
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Credential |
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Telephone | 917-484-1465
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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 | 0157731
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License Number State | NY
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