Provider Demographics
NPI:1326255753
Name:METRO SPORTS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:METRO SPORTS PHYSICAL THERAPY PC
Other - Org Name:METRO SPORTS PHYSICAL THERAPY PC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMICAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-759-2882
Mailing Address - Street 1:303 PARK AVE S
Mailing Address - Street 2:#1243
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3601
Mailing Address - Country:US
Mailing Address - Phone:212-759-2882
Mailing Address - Fax:212-759-2996
Practice Address - Street 1:885 2ND AVE
Practice Address - Street 2:LOBBY 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2201
Practice Address - Country:US
Practice Address - Phone:212-759-2882
Practice Address - Fax:212-759-2996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO SPORTS PHYSICAL THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy