MEDICARE: TOTAL DIMENTION THERAPY LLC.

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	208100000X	Physical Medicine & Rehabilitation Physician	022859	NY

General Provider Information

NPI Number	:	1104088699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL DIMENTION THERAPY LLC.

Provider Business Mailing Address
First Line	:	2421 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4905
Country	:	US
Telephone Number	:	718-616-1966
Fax Number	:	718-382-5252

Provider Business Practice Location Address
First Line	:	2421 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4905
Country	:	US
Telephone Number	:	718-616-1966
Fax Number	:	718-382-5252

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AHMED DARDEIR
Credential	:	DPT
Telephone Number	:	718-616-1966

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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