Provider Demographics
NPI:1538361100
Name:LYSAGHT, KEVIN H (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:H
Last Name:LYSAGHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:71 BANKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1738
Mailing Address - Country:US
Mailing Address - Phone:631-996-2420
Mailing Address - Fax:631-714-6142
Practice Address - Street 1:900 WALT WHITMAN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2293
Practice Address - Country:US
Practice Address - Phone:631-923-2288
Practice Address - Fax:631-714-6142
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021743-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist