Provider Demographics
NPI:1770876278
Name:FUNCTIONAL MANUAL PHYSICAL THERAPY SERVICES
Entity type:Organization
Organization Name:FUNCTIONAL MANUAL PHYSICAL THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-226-4816
Mailing Address - Street 1:62 CROSBY ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4410
Mailing Address - Country:US
Mailing Address - Phone:212-226-4816
Mailing Address - Fax:212-226-4814
Practice Address - Street 1:62 CROSBY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4410
Practice Address - Country:US
Practice Address - Phone:212-226-4816
Practice Address - Fax:212-226-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0214682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty