Provider Demographics
NPI:1053882613
Name:ACTIVE MOVEMENT PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:ACTIVE MOVEMENT PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYOUNGTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:929-333-4564
Mailing Address - Street 1:370 LEXINGTON AVE RM 312
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6564
Mailing Address - Country:US
Mailing Address - Phone:212-286-9800
Mailing Address - Fax:212-286-9801
Practice Address - Street 1:370 LEXINGTON AVE RM 312
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6564
Practice Address - Country:US
Practice Address - Phone:212-286-9800
Practice Address - Fax:212-286-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty