Provider Demographics
NPI:1215965397
Name:WALLKILL PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:WALLKILL PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-895-9003
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-0336
Mailing Address - Country:US
Mailing Address - Phone:845-895-9003
Mailing Address - Fax:845-895-9006
Practice Address - Street 1:1500 STATE ROUTE 208
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-3712
Practice Address - Country:US
Practice Address - Phone:845-895-9003
Practice Address - Fax:845-895-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255379525OtherNPI INDIVIDUAL PROVIDER #
11574902OtherCAQH #
1255379525OtherNPI INDIVIDUAL PROVIDER #
1255379525OtherNPI INDIVIDUAL PROVIDER #