Provider Demographics
NPI:1134241698
Name:THERAMOTION PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:THERAMOTION PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-279-9800
Mailing Address - Street 1:21426 41ST AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2166
Mailing Address - Country:US
Mailing Address - Phone:718-279-9800
Mailing Address - Fax:718-279-9500
Practice Address - Street 1:21426 41ST AVE STE 130
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2166
Practice Address - Country:US
Practice Address - Phone:718-279-9800
Practice Address - Fax:718-279-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023936-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06566Medicare PIN