Provider Demographics
NPI:1275805830
Name:BODY POWER PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BODY POWER PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BABU
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DSC,ECS,MTC
Authorized Official - Phone:516-623-6253
Mailing Address - Street 1:49 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3837
Mailing Address - Country:US
Mailing Address - Phone:516-623-6253
Mailing Address - Fax:516-623-8450
Practice Address - Street 1:49 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3837
Practice Address - Country:US
Practice Address - Phone:516-623-6253
Practice Address - Fax:516-623-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-29
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G100071330Medicare PIN
NYA100069435Medicare PIN