MEDICARE: LV PHYSICAL THERAPY, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1699564377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LV PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	108 ROYAL AVE
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-4322
Country	:	US
Telephone Number	:	631-213-1442
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 ROYAL AVE
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-4322
Country	:	US
Telephone Number	:	631-213-1442
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIA VELYS
Credential	:	PT, DPT, OCS
Telephone Number	:	631-213-1442

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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