MEDICARE: PREMIUM THERAPEUTICS

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1184578890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM THERAPEUTICS

Provider Business Mailing Address
First Line	:	1314 OCEAN PKWY APT 6C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5620
Country	:	US
Telephone Number	:	347-526-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 OCEAN PKWY APT 6C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5620
Country	:	US
Telephone Number	:	347-526-1502
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STANFORD JOSEPH
Credential	:	PHYSICAL THERAPY
Telephone Number	:	347-526-1502

Provider Enumeration Date	:	02/21/2026
Last Update Date	:	02/21/2026

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