MEDICARE: MOTION FORWARD PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1306780465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTION FORWARD PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	PO BOX 680018
Second Line	:
City	:	CORONA
State	:	NY
Zip	:	11368-0018
Country	:	US
Telephone Number	:	718-440-9560
Fax Number	:

Provider Business Practice Location Address
First Line	:	10408 ROOSEVELT AVE
Second Line	:
City	:	CORONA
State	:	NY
Zip	:	11368-4977
Country	:	US
Telephone Number	:	718-440-9560
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YTAN YUSUPOV
Credential	:
Telephone Number	:	718-440-9560

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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Directions to “MOTION FORWARD PHYSICAL THERAPY PC ” Practice Location

Language	Start Address	Practice Location

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