Healthcare Provider Details

I. General information

NPI: 1275702912
Provider Name (Legal Business Name): IN-MOTION PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 57TH ST SUITE 1406
NEW YORK NY
10019-2802
US

IV. Provider business mailing address

3636 33RD ST SUITE 403
ASTORIA NY
11106-2329
US

V. Phone/Fax

Practice location:
  • Phone: 212-399-3800
  • Fax: 212-399-3822
Mailing address:
  • Phone: 718-707-6970
  • Fax: 718-732-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number011188
License Number StateNY

VIII. Authorized Official

Name: DR. DIMITRIOS KOSTOPOULOS
Title or Position: OWNER
Credential:
Phone: 718-707-6970