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 provides Physical Therapist services 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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