MEDICARE: LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB, P.C.

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

General Provider Information

NPI Number	:	1225046899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 101
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-0101
Country	:	US
Telephone Number	:	678-571-3852
Fax Number	:	833-888-7868

Provider Business Practice Location Address
First Line	:	40 EXCHANGE PL
Second Line	:	SUITE 728
City	:	NEW YORK
State	:	NY
Zip	:	10005-2701
Country	:	US
Telephone Number	:	212-425-1060
Fax Number	:	646-527-9021

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SEAN WATERS
Credential	:	M.S.,P.T.
Telephone Number	:	412-654-3212

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/28/2018

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