Healthcare Provider Details

I. General information

NPI: 1659747384
Provider Name (Legal Business Name): CORE MOTION PT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ALBERTSON AVE
ALBERTSON NY
11507-1414
US

IV. Provider business mailing address

1 ALBERTSON AVE
ALBERTSON NY
11507-1414
US

V. Phone/Fax

Practice location:
  • Phone: 516-277-2054
  • Fax: 516-277-2055
Mailing address:
  • Phone: 516-277-2054
  • Fax: 516-277-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number020526-2
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ROBERT JOSEPH ACKERLY
Title or Position: OWNER
Credential: PHYSICAL THERAPIST
Phone: 516-277-2054