MEDICARE: LOTUS PHYSICAL THERAPY FOR WOMEN, PLLC

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	2251X0800X	Orthopedic Physical Therapist	0125481	NY

General Provider Information

NPI Number	:	1437399425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS PHYSICAL THERAPY FOR WOMEN, PLLC

Provider Business Mailing Address
First Line	:	667 S MOUNTAIN RD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-5709
Country	:	US
Telephone Number	:	914-282-5532
Fax Number	:	845-634-2402

Provider Business Practice Location Address
First Line	:	105 SHAD ROW
Second Line	:
City	:	PIERMONT
State	:	NY
Zip	:	10968-3001
Country	:	US
Telephone Number	:	914-282-5532
Fax Number	:	845-634-2402

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/MEMBER
Name	:	MS. LUBA L STAROSTIAK
Credential	:	PT
Telephone Number	:	914-282-5532

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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