Active NPI
Larry Lieberman
- Physical Therapist
- South Daytona, FL
National Provider Identifier
1619125663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 005134
- Practice address
- 917 Beville Rd
Suite G
South Daytona, FL 32119-1712 - Phone
- (386) 756-4395
- Fax
- (866) 426-2811
- NPI assigned
- Sep 3, 2008
- Last updated
- Sep 3, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 005134 | CT | Primary |
Addresses
Primary practice location
917 Beville Rd
Suite G
South Daytona, FL 32119-1712
Mailing address
34 Post Falls LN
Hamden, CT 06518-1025
Phone (203) 887-2526
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5134 | CT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220400000000",
"number": "1619125663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 POST FALLS LN",
"city": "HAMDEN",
"state": "CT",
"postal_code": "065181025",
"telephone_number": "203-887-2526",
"fax_number": "866-426-2811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 BEVILLE RD",
"address_2": "SUITE G",
"city": "SOUTH DAYTONA",
"state": "FL",
"postal_code": "321191712",
"telephone_number": "386-756-4395",
"fax_number": "866-426-2811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBERMAN",
"first_name": "LARRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-03",
"last_updated": "2008-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "005134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Daytona, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.