Provider Demographics
NPI:1528466612
Name:IMPETUS PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:IMPETUS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERPAY
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-360-8630
Mailing Address - Street 1:501 5TH AVE
Mailing Address - Street 2:ROOM 2200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6107
Mailing Address - Country:US
Mailing Address - Phone:718-360-8630
Mailing Address - Fax:
Practice Address - Street 1:501 5TH AVENUE
Practice Address - Street 2:ROOM 2200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:718-360-8630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherLC. 027944