Provider Demographics
NPI:1639310105
Name:MANUAL AND MOVEMENT BASED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MANUAL AND MOVEMENT BASED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-484-8246
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-0736
Mailing Address - Country:US
Mailing Address - Phone:914-484-8246
Mailing Address - Fax:
Practice Address - Street 1:1853 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4432
Practice Address - Country:US
Practice Address - Phone:914-484-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy