=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174859045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANHATTAN PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2009
-----------------------------------------------------
Last Update Date | 10/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 276 5TH AVE 202
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-754-0488
-----------------------------------------------------
Fax | 888-511-6713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 276 5TH AVE 202
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-4509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-754-0488
-----------------------------------------------------
Fax | 888-511-6713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. JOSEPH M SIMON
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 212-213-3480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 0234721
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------