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General NPI Number Information
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NPI Number | 1114469376
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Entity Type | Organization
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Legal Business Name | POWER OF MOVEMENT PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 2900 WESTCHESTER AVENUE SUITE 108
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City | PURCHASE
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State | NY
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Zip | 10577-2551
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Country | US
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Telephone | 914-364-0504
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Fax | 914-828-0100
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Provider Business Mailing Address
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Address Line | 11 STONE HOLLOW DR
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City | BREWSTER
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State | NY
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Zip | 10509-2678
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Country | US
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Telephone | 914-364-0504
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Fax | 914-828-0100
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA BRODERICK
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Credential | DPT
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Telephone | 914-364-0504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 025723
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License Number State | NY
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