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General NPI Number Information
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NPI Number | 1770876278
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL MANUAL PHYSICAL THERAPY SERVICES
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 62 CROSBY ST
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City | NEW YORK
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State | NY
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Zip | 10012-4410
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Country | US
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Telephone | 212-226-4816
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Fax | 212-226-4814
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Provider Business Mailing Address
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Address Line | 62 CROSBY ST
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City | NEW YORK
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State | NY
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Zip | 10012-4410
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Country | US
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Telephone | 212-226-4816
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Fax | 212-226-4814
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAD GILDEN
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Credential | DPT
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Telephone | 212-226-4816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 021468
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License Number State | NY
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