Provider Demographics
NPI:1235995408
Name:ACTIVE MOBILITY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ACTIVE MOBILITY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHURSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-680-5484
Mailing Address - Street 1:59 MARTIN RD N
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59 MARTIN RD N
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5119
Practice Address - Country:US
Practice Address - Phone:516-680-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty