Provider Demographics
NPI:1104993427
Name:SYMMETRY PHYSICAL THERAPY & WELLNESS, LLC
Entity type:Organization
Organization Name:SYMMETRY PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LAURETANI
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:914-738-1748
Mailing Address - Street 1:342 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1204
Mailing Address - Country:US
Mailing Address - Phone:914-738-1748
Mailing Address - Fax:914-738-1749
Practice Address - Street 1:342 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1204
Practice Address - Country:US
Practice Address - Phone:914-738-1748
Practice Address - Fax:914-738-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022415-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAWED1Medicare PIN