Provider Demographics
NPI:1790927184
Name:LIFELINE PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:LIFELINE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-269-0030
Mailing Address - Street 1:150 CORBIN PL APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4828
Mailing Address - Country:US
Mailing Address - Phone:347-526-4820
Mailing Address - Fax:
Practice Address - Street 1:150 CORBIN PL APT 6C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4874
Practice Address - Country:US
Practice Address - Phone:347-526-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019879-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy