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General NPI Number Information
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NPI Number | 1629603022
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Entity Type | Organization
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Legal Business Name | MOVEMENT HEADQUARTERS PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 67 BRIGHTSIDE AVE
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-1903
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Country | US
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Telephone | 631-681-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 10 STARLIT DR
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City | NORTHPORT
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State | NY
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Zip | 11768-3514
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Country | US
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Telephone | 631-681-7470
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK CLARK GATHMAN
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Credential | PT, DPT, CSCS
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Telephone | 631-681-7470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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