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Organization
FORM PHYSICAL THERAPY LIFESTYLE WELLNESS PLLC
Active
Organization
FORM PHYSICAL THERAPY LIFESTYLE WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN THOMAS (PRACTICE ADMINISTRATOR)
(833) 442-2053
Entity
Organization
Contact information
Practice address
21426 41ST AVE STE 110, BAYSIDE, NY 11361-2149
(718) 279-9800
Mailing address
21426 41ST AVE STE 110, BAYSIDE, NY 11361-2149
(718) 279-9800
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/17/2026
Last updated
06/17/2026
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