Provider Demographics
NPI:1740508910
Name:PRIME MOVERS PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:PRIME MOVERS PHYSICAL THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORGANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-359-9593
Mailing Address - Street 1:469 FASHION AVENUE
Mailing Address - Street 2:SUITE 327-328
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018
Mailing Address - Country:US
Mailing Address - Phone:212-359-9592
Mailing Address - Fax:718-775-3419
Practice Address - Street 1:2752 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-769-9001
Practice Address - Fax:718-796-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022691225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02773393Medicaid
NYO2425038Medicaid
NYA100032991Medicare PIN
NYO2425038Medicaid