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General NPI Number Information
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NPI Number | 1093222481
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Entity Type | Organization
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Legal Business Name | MOTIV8 PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 01/07/2018
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 636 BROADWAY FL 2
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City | NEW YORK
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State | NY
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Zip | 10012-2607
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Country | US
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Telephone | 917-972-3463
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 DEAN ST APT 3D
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City | BROOKLYN
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State | NY
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Zip | 11213-1980
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Country | US
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Telephone | 917-972-3463
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. EVELYN C. HERRERA
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Credential | PT, DPT, CSCS
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Telephone | 917-972-3463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 024497
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License Number State | NY
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