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General NPI Number Information
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NPI Number | 1225478662
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Entity Type | Organization
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Legal Business Name | MOVEMENT PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 06/30/2013
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Last Update Date | 06/30/2013
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Provider Practice Location Address
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Address Line | 333 E 102ND ST APT 721
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City | NEW YORK
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State | NY
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Zip | 10029-5664
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Country | US
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Telephone | 917-775-4579
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Fax | 917-675-6907
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Provider Business Mailing Address
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Address Line | 333 E 102ND ST APT 721
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City | NEW YORK
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State | NY
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Zip | 10029-5664
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Country | US
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Telephone | 917-775-4579
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Fax | 917-675-6907
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Authorized Official
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Title or Position | CEO
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Name | MR. ROLAND ANCHETA GANDEZA
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Credential | PT
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Telephone | 917-775-4579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 032716-1
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License Number State | NY
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