Healthcare Provider Details

I. General information

NPI: 1801669494
Provider Name (Legal Business Name): MDM PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAPLEWOOD AVE
HEMPSTEAD NY
11550-6414
US

IV. Provider business mailing address

80 MAPLEWOOD AVE
HEMPSTEAD NY
11550-6414
US

V. Phone/Fax

Practice location:
  • Phone: 516-481-3564
  • Fax: 516-481-3564
Mailing address:
  • Phone: 516-481-3564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL MURRAY
Title or Position: PRESIDENT
Credential: DPT
Phone: 516-481-3564