Provider Demographics
NPI:1689844052
Name:GYPRAIN PHYSICAL THERAPY, REHABILITATION, FITNESS CONSULTING PC
Entity type:Organization
Organization Name:GYPRAIN PHYSICAL THERAPY, REHABILITATION, FITNESS CONSULTING PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASTLEY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:917-538-2038
Mailing Address - Street 1:10 MORTON ST
Mailing Address - Street 2:#3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4007
Mailing Address - Country:US
Mailing Address - Phone:917-538-2038
Mailing Address - Fax:212-924-5842
Practice Address - Street 1:10 MORTON ST
Practice Address - Street 2:#3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4007
Practice Address - Country:US
Practice Address - Phone:917-538-2038
Practice Address - Fax:212-924-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-02
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027427225100000X, 2251E1200X, 2251G0304X, 2251H1200X, 2251P0200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty