Provider Demographics
NPI:1376852897
Name:METROPOLITAN KIDS MOVEMENT, PT,OT,SLP, LLC
Entity Type:Organization
Organization Name:METROPOLITAN KIDS MOVEMENT, PT,OT,SLP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-863-2902
Mailing Address - Street 1:427 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3999
Mailing Address - Country:US
Mailing Address - Phone:646-863-2908
Mailing Address - Fax:646-863-2913
Practice Address - Street 1:427 E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3999
Practice Address - Country:US
Practice Address - Phone:646-863-2908
Practice Address - Fax:646-863-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026499-1252Y00000X
NY012523-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency