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General NPI Number Information
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NPI Number | 1669757746
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Entity Type | Organization
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Legal Business Name | ACTIVE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 2127 PALMER AVENUE
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City | LARCHMONT
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State | NY
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Zip | 10538
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Country | US
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Telephone | 914-630-7724
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Fax | 914-630-7725
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Provider Business Mailing Address
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Address Line | 2127 PALMER AVENUE
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City | LARCHMONT
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State | NY
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Zip | 10538
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Country | US
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Telephone | 914-630-7724
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Fax | 914-630-7725
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DERRICK M MAY
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Credential | PT, MS
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Telephone | 914-630-7724
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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 | 025433-1
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License Number State | NY
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