Provider Demographics
NPI:1649676818
Name:LAKSHMI PT OT SLP MASSAGE CONSULTANTS PLLC
Entity type:Organization
Organization Name:LAKSHMI PT OT SLP MASSAGE CONSULTANTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-442-1055
Mailing Address - Street 1:509 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5436
Mailing Address - Country:US
Mailing Address - Phone:516-442-1055
Mailing Address - Fax:516-442-1056
Practice Address - Street 1:509 MERRICK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5436
Practice Address - Country:US
Practice Address - Phone:516-442-1055
Practice Address - Fax:516-442-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023963-1225X00000X
NY021687225100000X
NY018479208100000X
NY026741-1235Z00000X
NY022753-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty