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NPI Code Detail

MEDICARE: BALANCED ROCK PT PC

MEDICARE: BALANCED ROCK PT PC
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
1225100000XPhysical Therapist031395NY

General Provider Information

NPI Number : 1518323534
Entity Type Code : Organization
Provider Name (Legal Business Name) : BALANCED ROCK PT PC
Provider Business Mailing Address
First Line : 10825 MERRICK BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11433-2906
Country : US
Telephone Number : 718-658-9700
Fax Number :
Provider Business Practice Location Address
First Line : 10825 MERRICK BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11433-2906
Country : US
Telephone Number : 718-658-9700
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JOANNA M KULIS
Credential : PT
Telephone Number : 718-658-9700
Provider Enumeration Date : 01/06/2016
Last Update Date : 01/06/2016

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Directions to “BALANCED ROCK PT PC ” Practice Location

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