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General NPI Number Information
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NPI Number | 1356696579
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Entity Type | Organization
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Legal Business Name | IMPACT PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 07/14/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 60 DUTCH HILL RD 2
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City | ORANGEBURG
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State | NY
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Zip | 10962-1723
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Country | US
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Telephone | 201-660-2485
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Fax | 845-359-2095
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Provider Business Mailing Address
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Address Line | 60 DUTCH HILL RD 2
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City | ORANGEBURG
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State | NY
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Zip | 10962-1723
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Country | US
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Telephone | 201-660-2485
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Fax | 845-359-2095
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JAMIE NAMSU YI
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Credential | PT
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Telephone | 201-660-2485
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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 | 017357
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License Number State | NY
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