Provider Demographics
NPI:1639695398
Name:MODERN MOVEMENT PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:MODERN MOVEMENT PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSHAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-416-2209
Mailing Address - Street 1:8429 LORRAINE RD # 127
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-9010
Mailing Address - Country:US
Mailing Address - Phone:917-416-2209
Mailing Address - Fax:
Practice Address - Street 1:18017 GAWTHROP DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211
Practice Address - Country:US
Practice Address - Phone:917-416-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031866225100000X, 2251S0007X, 225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty