| Organization Name: | AGEWELL PHYSICAL THERAPY AND WELLNESS, P.C. |
| NPI Number: | 1861485070 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK HERBRICH (CO-FOUNDER/ PHYSICAL THERAPIST) |
| Mailing Address: | 1999 Marcus Ave Suite M15 Lake Success |
| State: | NY US |
| Postal Code: | 110421013 |
| Phone Number: | 5164888808 |
| Fax Number: | 5164888818 |
| NPI Enumeration Date: | 08/24/2005 |
| NPI Last Update Date: | 03/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 0155321 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |