1023489531 NPI number — MOVEMENT VALUED MANUAL THERAPY PHYSICAL THERAPY, PLLC

Table of content: (NPI 1023489531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023489531 NPI number — MOVEMENT VALUED MANUAL THERAPY PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOVEMENT VALUED MANUAL THERAPY PHYSICAL THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023489531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 W 35TH ST RM 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-2249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-430-5717
Provider Business Mailing Address Fax Number:
646-514-1972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 W 35TH ST RM 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-2249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-430-5717
Provider Business Practice Location Address Fax Number:
646-514-1972
Provider Enumeration Date:
10/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LUSK
Authorized Official First Name:
MARK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT, PHYSICAL THERAPIST
Authorized Official Telephone Number:
646-430-5717

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  031569 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com