Provider Demographics
NPI:1982859765
Name:MULDER FAMILY PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:MULDER FAMILY PHYSICAL THERAPY, P.C.
Other - Org Name:AMSTERDAM PHYSICAL THERAPY, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-887-7100
Mailing Address - Street 1:515 ROUTE 111
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4339
Mailing Address - Country:US
Mailing Address - Phone:631-887-7100
Mailing Address - Fax:631-382-8620
Practice Address - Street 1:515 ROUTE 111
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4339
Practice Address - Country:US
Practice Address - Phone:631-887-7100
Practice Address - Fax:631-382-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty