MEDICARE: KARINA GUREVICH MSPT

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

General Provider Information

NPI Number	:	1093770430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA GUREVICH MSPT

Provider Business Mailing Address
First Line	:	1429 SHORE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6133
Country	:	US
Telephone Number	:	718-266-0008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1429 SHORE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6144
Country	:	US
Telephone Number	:	718-266-0008
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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