Provider Demographics
NPI:1447805767
Name:MOVEMENT POTENTIAL PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:MOVEMENT POTENTIAL PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CSCS
Authorized Official - Phone:516-297-5581
Mailing Address - Street 1:1765 MERIKOKE AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3311
Mailing Address - Country:US
Mailing Address - Phone:516-297-5581
Mailing Address - Fax:
Practice Address - Street 1:1765 MERIKOKE AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3311
Practice Address - Country:US
Practice Address - Phone:516-297-5581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty