MEDICARE: MRS. STINA MARIE LAWYER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	022416-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QI9091	OTHER	NY	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1205074549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STINA MARIE LAWYER P.T.

Provider Business Mailing Address
First Line	:	2343 NEW HYDE PARK RD
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1212
Country	:	US
Telephone Number	:	516-302-8501
Fax Number	:

Provider Business Practice Location Address
First Line	:	2343 NEW HYDE PARK RD
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1212
Country	:	US
Telephone Number	:	516-302-8501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	01/23/2009

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