MEDICARE: MS. LAUREN SCULLY PT, DPT, PRPC

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	029153-1	NY

General Provider Information

NPI Number	:	1417166075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN SCULLY PT, DPT, PRPC

Provider Business Mailing Address
First Line	:	150 55TH ST
Second Line	:	LUTHERAN MEDICAL CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2559
Country	:	US
Telephone Number	:	718-630-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 SHORE ROAD, EAST BUILDING, LOWER LOBBY
Second Line	:	SHORE ROAD REHABILITATION
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5449
Country	:	US
Telephone Number	:	718-921-2945
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/06/2016

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