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General NPI Number Information
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NPI Number | 1982954517
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Entity Type | Organization
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Legal Business Name | LOTUS PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 11 STEWART AVE
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City | HUNTINGTON
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State | NY
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Zip | 11743-2738
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Country | US
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Telephone | 631-629-5507
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Fax |
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Provider Business Mailing Address
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Address Line | 39 OAKDALE RD
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City | CENTERPORT
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State | NY
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Zip | 11721-1530
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Country | US
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Telephone | 718-986-2410
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. RACHELLE BOJER
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Credential | MSPT
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Telephone | 631-629-5507
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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 | 022578-1
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License Number State | NY
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