Healthcare Provider Details

I. General information

NPI: 1386677920
Provider Name (Legal Business Name): PERFORMING ARTS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CEDAR ST
HASTINGS ON HUDSON NY
10706-3905
US

IV. Provider business mailing address

13 CEDAR ST
HASTINGS ON HUDSON NY
10706-3905
US

V. Phone/Fax

Practice location:
  • Phone: 212-245-7278
  • Fax: 212-245-7461
Mailing address:
  • Phone: 212-245-7278
  • Fax: 212-245-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number009366-1
License Number StateNY

VIII. Authorized Official

Name: MR. SEAN PADRIC GALLAGHER
Title or Position: OWNER
Credential: PT
Phone: 212-245-7178