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General NPI Number Information
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NPI Number | 1750655056
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Entity Type | Organization
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Legal Business Name | PHYSIOMOTION PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 86 BOWERY FL 6
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City | NEW YORK
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State | NY
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Zip | 10013-4615
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Country | US
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Telephone | 212-219-9197
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Fax |
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Provider Business Mailing Address
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Address Line | 22159 HORACE HARDING EXPY FL 2
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2320
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Country | US
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Telephone | 917-951-3953
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | WAYNE LI
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Credential | PT
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Telephone | 917-951-3953
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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 | 023663
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License Number State | NY
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