MEDICARE: BRONX DEKALB PHYSICAL THERAPY

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	261QP2000X	Physical Therapy Clinic/Center	013814-1	NY

General Provider Information

NPI Number	:	1528215738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX DEKALB PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3435 DEKALB AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2301
Country	:	US
Telephone Number	:	718-547-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 DEKALB AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2301
Country	:	US
Telephone Number	:	718-547-8899
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MRS. MA.ANELYN C. SUAZO
Credential	:	PT
Telephone Number	:	845-309-3163

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	09/11/2008

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