MEDICARE: QUEENS BROOKLYN 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1558216648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEENS BROOKLYN PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6093 MYRTLE AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5926
Country	:	US
Telephone Number	:	718-490-9909
Fax Number	:	347-223-4405

Provider Business Practice Location Address
First Line	:	6093 MYRTLE AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5926
Country	:	US
Telephone Number	:	718-490-9909
Fax Number	:	347-223-4405

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVER TELLO
Credential	:	PT
Telephone Number	:	917-295-1025

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “QUEENS BROOKLYN PHYSICAL THERAPY ” Practice Location

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