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General NPI Number Information
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NPI Number | 1790110518
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Entity Type | Organization
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Legal Business Name | MOVING FORWARD PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 605 MADISON AVE 4TH FLOOR/JFGYMNASTIQUE
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City | NEW YORK
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State | NY
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Zip | 10022-1900
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Country | US
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Telephone | 917-604-8612
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Fax | 888-705-2297
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Provider Business Mailing Address
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Address Line | 116 E 60TH ST SUITE 5B
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City | NEW YORK
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State | NY
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Zip | 10022-1107
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Country | US
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Telephone | 917-604-8612
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. VITALY DVOSKIN
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Credential | PT, DPT
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Telephone | 917-604-8612
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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 | 40QA01328300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 36260
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License Number State | CA
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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 | 030873
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License Number State | NY
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