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General NPI Number Information
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NPI Number | 1639695398
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Entity Type | Organization
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Legal Business Name | MODERN MOVEMENT PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 18017 GAWTHROP DR
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City | BRADENTON
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State | FL
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Zip | 34211
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Country | US
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Telephone | 917-416-2209
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Fax |
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Provider Business Mailing Address
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Address Line | 8429 LORRAINE RD # 127
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-9010
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Country | US
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Telephone | 917-416-2209
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | EUGENE BARSHAY
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Credential | PT
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Telephone | 917-416-2209
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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 | 031866
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 031866
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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