Provider Demographics
NPI:1982954517
Name:LOTUS PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:LOTUS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:631-629-5507
Mailing Address - Street 1:39 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1530
Mailing Address - Country:US
Mailing Address - Phone:718-986-2410
Mailing Address - Fax:
Practice Address - Street 1:11 STEWART AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2738
Practice Address - Country:US
Practice Address - Phone:631-629-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022578-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL2322Medicare PIN