Provider Demographics
NPI:1093911646
Name:FINISH LINE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:FINISH LINE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CONLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-486-8573
Mailing Address - Street 1:119 W 23RD ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2427
Mailing Address - Country:US
Mailing Address - Phone:212-486-8573
Mailing Address - Fax:
Practice Address - Street 1:119 W 23RD ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2427
Practice Address - Country:US
Practice Address - Phone:212-486-8573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018121-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty