Provider Demographics
NPI:1750655056
Name:PHYSIOMOTION PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:PHYSIOMOTION PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-951-3953
Mailing Address - Street 1:22159 HORACE HARDING EXPY FL 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2320
Mailing Address - Country:US
Mailing Address - Phone:917-951-3953
Mailing Address - Fax:
Practice Address - Street 1:86 BOWERY FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4615
Practice Address - Country:US
Practice Address - Phone:212-219-9197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty