MEDICARE: DR. REYLITO POLIQUIT PUMARADA PT, DPT

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	2251X0800X	Orthopedic Physical Therapist	020030	NY
2	2251N0400X	Neurology Physical Therapist	020030	NY
3	2251G0304X	Geriatric Physical Therapist	020030	NY
4	225100000X	Physical Therapist	020030	NY
5	2251P0200X	Pediatric Physical Therapist	020030	NY
6	2251S0007X	Sports Physical Therapist	020030	NY

General Provider Information

NPI Number	:	1073654398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REYLITO POLIQUIT PUMARADA PT, DPT

Provider Business Mailing Address
First Line	:	126 HUNTER AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-4602
Country	:	US
Telephone Number	:	631-669-0415
Fax Number	:	631-669-1455

Provider Business Practice Location Address
First Line	:	126 HUNTER AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-4602
Country	:	US
Telephone Number	:	631-669-0415
Fax Number	:	631-669-1455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	10/27/2008

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