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Contact Information

AGEWELL PHYSICAL THERAPY AND WELLNESS, P.C.
1999 MARCUS AVE
SUITE M15
LAKE SUCCESS, NY11042-1013
 Phone: 516-488-8808
 Fax: 516-488-8818
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for AGEWELL PHYSICAL THERAPY AND WELLNESS, P.C.

NPI # 1861485070
LBN Legal business name AGEWELL PHYSICAL THERAPY AND WELLNESS, P.C.
Authorized official MARK HERBRICH - (CO-FOUNDER/ PHYSICAL THERAPIST)
Entity Organization
Organization subpart 1 No
Enumeration date 08/24/2005
Last updated 03/13/2008 - About 18 years ago
Identifiers
NY License # 0155321
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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