Provider Demographics
NPI:1316331200
Name:FUNCTION IN MOTION PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:FUNCTION IN MOTION PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIC
Authorized Official - Middle Name:GUERRERO
Authorized Official - Last Name:BALAOING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-942-5133
Mailing Address - Street 1:5501 31ST AVE UNIT 3CH
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1645
Mailing Address - Country:US
Mailing Address - Phone:347-807-8132
Mailing Address - Fax:718-942-5134
Practice Address - Street 1:930 SHERIDAN AVE STE 5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3339
Practice Address - Country:US
Practice Address - Phone:718-942-5133
Practice Address - Fax:718-942-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03374870Medicaid
NY04897985Medicaid