Provider Demographics
NPI:1194875674
Name:LISA PRIMICH PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:LISA PRIMICH PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-398-5700
Mailing Address - Street 1:259 GARFIELD PL
Mailing Address - Street 2:#1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2249
Mailing Address - Country:US
Mailing Address - Phone:718-398-5700
Mailing Address - Fax:718-569-0404
Practice Address - Street 1:665 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1207
Practice Address - Country:US
Practice Address - Phone:718-398-5700
Practice Address - Fax:718-569-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ6WDB1Medicare ID - Type UnspecifiedGROUP PT NUMBER