Provider Demographics
NPI:1831464973
Name:PROGRESSIVE MOVEMENT PHYSICAL THERAPY AND SPORTS REHAB PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE MOVEMENT PHYSICAL THERAPY AND SPORTS REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-774-1888
Mailing Address - Street 1:74 E 79TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0266
Mailing Address - Country:US
Mailing Address - Phone:212-774-1888
Mailing Address - Fax:212-774-1889
Practice Address - Street 1:74 E 79TH ST APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0266
Practice Address - Country:US
Practice Address - Phone:212-774-1888
Practice Address - Fax:212-774-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1568618817OtherPERSONAL