1144563990 NPI number — CLUTCH PHYSICAL THERAPY PLLC

Table of content: (NPI 1144563990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144563990 NPI number — CLUTCH PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLUTCH PHYSICAL THERAPY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144563990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 2ND AVE
Provider Second Line Business Mailing Address:
PLAZA
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-203-6802
Provider Business Mailing Address Fax Number:
212-377-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1690 2ND AVE
Provider Second Line Business Practice Location Address:
PLAZA
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-203-6802
Provider Business Practice Location Address Fax Number:
212-377-5741
Provider Enumeration Date:
03/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHLMAN
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER/CHIEF ATHLETE MECHANIC
Authorized Official Telephone Number:
212-203-6802

Provider Taxonomy Codes

  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: 032171-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1740507045 . This is a "MEDICARE NPI FOR ME/OWNER/FOUNDER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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