Provider Demographics
NPI:1225478662
Name:MOVEMENT PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MOVEMENT PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:ANCHETA
Authorized Official - Last Name:GANDEZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-775-4579
Mailing Address - Street 1:333 E 102ND ST APT 721
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5664
Mailing Address - Country:US
Mailing Address - Phone:917-775-4579
Mailing Address - Fax:917-675-6907
Practice Address - Street 1:333 E 102ND ST APT 721
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5664
Practice Address - Country:US
Practice Address - Phone:917-775-4579
Practice Address - Fax:917-675-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032716-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health