MEDICARE: RED CORE PTPTA AND REHABILITATION PLLC

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	:	1457985202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED CORE PTPTA AND REHABILITATION PLLC

Provider Business Mailing Address
First Line	:	PO BOX 780173
Second Line	:
City	:	MASPETH
State	:	NY
Zip	:	11378-0173
Country	:	US
Telephone Number	:	718-509-9888
Fax Number	:	718-509-6144

Provider Business Practice Location Address
First Line	:	18239 JAMAICA AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2329
Country	:	US
Telephone Number	:	718-509-9888
Fax Number	:	718-509-6144

Authorized Official
Title or Position	:	SENIOR PHYSICAL THERAPIST
Name	:	RALPH WALDO CUARTERO
Credential	:
Telephone Number	:	718-509-9888

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	03/02/2020

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