Healthcare Provider Details

I. General information

NPI: 1003663998
Provider Name (Legal Business Name): ADAPTIVE MOVEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 FRANCIS LEWIS BLVD # LL107
BAYSIDE NY
11361-2573
US

IV. Provider business mailing address

24 CLARK DR
GREAT NECK NY
11020-1534
US

V. Phone/Fax

Practice location:
  • Phone: 516-849-5208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JOVELYN ASIA-NACAR
Title or Position: OWNER
Credential: PT,DPT
Phone: 516-849-5208