MEDICARE: PHYSICAL THERAPY OF QUEENS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	016017	NY

General Provider Information

NPI Number	:	1023288487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY OF QUEENS PC

Provider Business Mailing Address
First Line	:	8523 FORT HAMILTON PKWY APT 3F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4822
Country	:	US
Telephone Number	:	718-450-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2234
Country	:	US
Telephone Number	:	718-450-7070
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AHMED MAHMOUD ELMANSY
Credential	:	PT
Telephone Number	:	718-450-7070

Provider Enumeration Date	:	03/01/2008
Last Update Date	:	07/18/2016

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