Provider Demographics
NPI:1861548018
Name:LAI, TAK Y (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:TAK
Middle Name:Y
Last Name:LAI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 JACKSON TER
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1427
Mailing Address - Country:US
Mailing Address - Phone:201-612-0987
Mailing Address - Fax:201-612-1221
Practice Address - Street 1:432 JACKSON TER
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1427
Practice Address - Country:US
Practice Address - Phone:201-612-0987
Practice Address - Fax:201-612-1221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00644100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist