MEDICARE: BODHIMOTION PHYSICAL THERAPY AND WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	023936	NY
2	225100000X	Physical Therapist	023860	NY

General Provider Information

NPI Number	:	1205130622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODHIMOTION PHYSICAL THERAPY AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	110 E 23RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-4517
Country	:	US
Telephone Number	:	212-529-5700
Fax Number	:	212-529-3415

Provider Business Practice Location Address
First Line	:	155 E 31ST ST
Second Line	:	APT 15A
City	:	NEW YORK
State	:	NY
Zip	:	10016-6800
Country	:	US
Telephone Number	:	212-529-5700
Fax Number	:	212-529-3415

Authorized Official
Title or Position	:	OWNER/ORGANIZER
Name	:	DR. SCOTT WEISS
Credential	:	DPT
Telephone Number	:	212-529-5700

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	03/18/2015

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