Provider Demographics
NPI:1588642201
Name:ST. MARKS PHYSICAL THERAPY, P.C
Entity Type:Organization
Organization Name:ST. MARKS PHYSICAL THERAPY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORGANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-600-9299
Mailing Address - Street 1:800 2ND AVENUE
Mailing Address - Street 2:SUITE 802
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-600-9299
Mailing Address - Fax:718-775-3419
Practice Address - Street 1:800 2ND AVENUE
Practice Address - Street 2:SUITE 802
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-600-9299
Practice Address - Fax:718-775-3419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARKS PHYSICAL THERAPY, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-03
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022691225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q4W9N1Medicare ID - Type Unspecified