Provider Demographics
NPI:1083724264
Name:PRO MOTION PHYSICAL THERAPY,P.C.
Entity type:Organization
Organization Name:PRO MOTION PHYSICAL THERAPY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-599-4475
Mailing Address - Street 1:1019 STATE ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1643
Mailing Address - Country:US
Mailing Address - Phone:845-781-5890
Mailing Address - Fax:845-781-7916
Practice Address - Street 1:1019 STATE ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1643
Practice Address - Country:US
Practice Address - Phone:845-781-5890
Practice Address - Fax:845-781-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ81663Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY03144Medicare ID - Type UnspecifiedGHI MEDICARE