Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Form Physical Therapy Lifestyle Wellness PLLC

Organization Physical Therapist · NPI 1629903760

Form Physical Therapy Lifestyle Wellness PLLC is a Physical Therapist in Bayside, New York. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

21426 41st Ave Ste 110
Bayside, NY 11361-2149
Phone: (718) 279-9800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1629903760
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Dan Thomas — Practice Administrator · (833) 442-2053
NPI enumeratedJune 17, 2026
Last updated in NPPESJune 17, 2026
Certification dateJune 17, 2026
Mailing address21426 41st Ave Ste 110, Bayside, NY 11361-2149

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