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General NPI Number Information
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NPI Number | 1730705799
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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 | 06/24/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 279 E 44TH ST APT 18D
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City | NEW YORK
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State | NY
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Zip | 10017-4351
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Country | US
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Telephone | 516-603-9024
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Fax |
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Provider Business Mailing Address
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Address Line | 279 E 44TH ST APT 18D
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City | NEW YORK
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State | NY
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Zip | 10017-4351
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Country | US
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Telephone | 516-603-9024
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DYLANN CRAIG GERMANN
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Credential | DPT
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Telephone | 516-603-9024
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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 |
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License Number State |
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