Provider Demographics
NPI:1386244739
Name:LAKESIDE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LAKESIDE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:MONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:973-329-0099
Mailing Address - Street 1:31 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2312
Mailing Address - Country:US
Mailing Address - Phone:973-699-3319
Mailing Address - Fax:
Practice Address - Street 1:115 US HIGHWAY 46 STE B11
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1656
Practice Address - Country:US
Practice Address - Phone:973-329-0099
Practice Address - Fax:973-329-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty