Provider Demographics
NPI:1689673691
Name:ACTIVE MOTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACTIVE MOTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-922-2977
Mailing Address - Street 1:27 AUDREY AVE
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-1522
Mailing Address - Country:US
Mailing Address - Phone:516-922-2977
Mailing Address - Fax:516-922-2975
Practice Address - Street 1:27 AUDREY AVE
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-1522
Practice Address - Country:US
Practice Address - Phone:516-922-2977
Practice Address - Fax:516-922-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ82883OtherBCBS
NY01981704Medicaid
NYANCG43OtherOXFORD
NYQ82883OtherBCBS