Provider Demographics
NPI:1356057368
Name:BE ACTIVE MOVEMENT PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BE ACTIVE MOVEMENT PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYOUNGTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:929-333-4564
Mailing Address - Street 1:4917 OVERBROOK ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1116
Mailing Address - Country:US
Mailing Address - Phone:929-333-4564
Mailing Address - Fax:212-286-9801
Practice Address - Street 1:370 LEXINGTON AVE RM 312
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6564
Practice Address - Country:US
Practice Address - Phone:929-333-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy