Provider Demographics
NPI:1902424120
Name:INTEGRATIVE MANUAL PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:INTEGRATIVE MANUAL PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEB
Authorized Official - Middle Name:
Authorized Official - Last Name:KARTSEV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-264-4128
Mailing Address - Street 1:261 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1216
Mailing Address - Country:US
Mailing Address - Phone:646-755-8838
Mailing Address - Fax:
Practice Address - Street 1:261 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1216
Practice Address - Country:US
Practice Address - Phone:646-755-8838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty